Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis.

Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis.

Acta Obstet Gynecol Scand. 2017 Sep 30;:

Authors: Pagani G, Cali G, Acharya G, Timor Trisch I, Palacios-Jaraquemada J, Familiari A, Buca D, Manzoli L, Flacco ME, Fanfani F, Liberati M, Scambia G, D'Antonio F

Abstract
INTRODUCTION: Our objective was to elucidate the overall diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation (AIP).
MATERIAL AND METHODS: Medline, Embase, CINAHL and The Cochrane databases were searched. The ultrasound signs explored were: loss of hypoechoic (clear) zone in the placental-uterine interface, placental lacunae, bladder wall interruption, myometrial thinning, focal exophitic mass, placental lacunar flow, sub-placental vascularity, and uterovescical hypervascularity.
RESULTS: Twenty studies (3209 pregnancies) were included. Ultrasound had an overall good diagnostic accuracy in identifying the depth of placental invasion with a sensitivity of 90.6%, 93.0%, 89.5% and 81.2% for placenta accreta, increta, accreta/increta and percreta respectively; the corresponding figures for specificity were 97.1%, 98.4%, 94.7%, 98.9%. Placental lacunae had a sensitivity of 74.8%, 88.6% and 76.3% for the detection of placenta accreta, increta and percreta respectively. Sensitivity and specificity of loss of the clear zone in identifying placenta accreta were 74.9% and 92.0%, while the corresponding figures for placenta increta and percreta were 91.6% and 76.9% and 88.1% and 71.1%. Lacunar flow had a sensitivity of 81.2%, 84.3% and 45.2% for the detection of placenta accreta, increta and percreta respectively; the corresponding figures for specificity were 84.0%, 79.7% and 75.3%. Sensitivity of uterovescical hypervascularity was low for the detection of placenta accreta (12.3%) while it was high for placenta increta (94.4%) and percreta (86.2%); the corresponding figures for specificity were 90.8%, 88.0% and 88.2% respectively.
CONCLUSIONS: Ultrasound has an overall good diagnostic accuracy in recognizing the depth and the topography of placental invasion. This article is protected by copyright. All rights reserved.

PMID: 28963728 [PubMed - as supplied by publisher]

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