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Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: systematic review and meta‐analysis

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Tinari, S., Buca, D., Cali, G., Timor‐Tritsch, I., Palacios‐Jaraquemada, J., Rizzo, G., Lucidi, A., Di Mascio, D. +2 more·2021·Ultrasound in Obstetrics & Gynecology
DOI 10.1002/uog.22183
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Abstract

Objective: To elucidate the risk factors, histopathological correlations and diagnostic accuracy of prenatal imaging in pregnancies complicated by posterior placenta accreta spectrum (PAS) disorders. Methods: MEDLINE, EMBASE and CINAHL were searched for studies reporting on women with posterior PAS. Inclusion criteria were women with posterior PAS confirmed either at surgery or on histopathological analysis. The outcomes explored were risk factors for posterior PAS, histopathological correlation and the diagnostic accuracy of ultrasound and magnetic resonance imaging (MRI) in detecting posterior PAS. Random‐effects meta‐analysis of proportions was used to analyze the data. Results: Twenty studies were included. Placenta previa was present in 92.8% (107/114; 17 studies) of pregnancies complicated by posterior PAS, while 76.1% (53/88; 11 studies) of women had had prior uterine surgery, mainly a Cesarean section (CS) or curettage and 82.5% (66/77; 10 studies) were multiparous. When considering histopathological analysis in women affected by posterior PAS, 77.5% (34/44; 11 studies) had placenta accreta, 19.5% (8/44; 11 studies) had placenta increta and 9.3% (2/44; 11 studies) had placenta percreta. Of the cases of posterior PAS disorder, 52.4% (31/63; 12 studies) were detected prenatally on ultrasound, while 46.7% (32/63; 12 studies) were diagnosed only at birth. When exploring the distribution of the classic ultrasound signs of PAS, placental lacunae were present in 39.0% (12/30; seven studies), loss of the clear zone in 41.1% (13/30; seven studies) and bladder‐wall interruption in 16.6% (4/30; seven studies) of women, while none of the included cases showed hypervascularization at the bladder‐wall interface. When assessing the role of MRI in detecting posterior PAS, 73.5% (26/32; 11 studies) of cases were detected on prenatal MRI, while 26.5% (6/32; 11 studies) were discovered only at the time of CS. Conclusions: Placenta previa, prior uterine surgery and multiparity represent the most commonly reported risk factors for posterior PAS. Ultrasound had a very low diagnostic accuracy in detecting these disorders prenatally. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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  • MRI plays an important role in PAS, such as for surgical planning and in the assessment of posterior or lateral defects.

    “MRI plays an important role, such as for surgical planning and in the assessment of posterior or lateral defects [5, 7, 8].”

    From Radiomics-based prediction of FIGO grade for placenta accreta spectrum (2023) · cites this paper as [7]

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Research works printed but not linked: 2

  1. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, Moher D, Becker BJ, Sipe TA, Thacker SB. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008-2012.
  2. Cochrane Handobook for Systematic Reviews of Diagnostic Test Accuracy, Chapter 10. http://srdta.cochra ne.org/handbook-dta-reviews.

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Authors
Tinari, S., Buca, D., Cali, G., Timor‐Tritsch, I., Palacios‐Jaraquemada, J., Rizzo, G., Lucidi, A., Di Mascio, D., Liberati, M., & D'Antonio, F.
Affiliations
  • University of Chieti-Pescara (IT)
  • Department of Obstetrics and Gynaecology, Arnas Civico Hospital Palermo Italy
  • New York University (US)
  • Centre for Medical Education and Clinical Research (CEMIC) University Hospital Buenos Aires Argentina
  • University of Rome Tor Vergata (IT)
  • Department of Maternal and Child Health and Urological Sciences Sapienza University of Rome Rome Italy
  • Centre for High Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology University of Chieti Chieti Italy
ORCID
Venue
Ultrasound in Obstetrics & Gynecology
Publisher
Wiley
Published
2021-06
Volume
57
Issue
6
Pages
903-909
ISSN
  • 0960-7692 (ISSN-L)
  • 1469-0705
DOI
10.1002/uog.22183
OpenAlex
W3080763615
Cited by
89
References
43
Citations by year
2026: 7 · 2025: 13 · 2024: 22 · 2023: 13 · 2022: 20 · 2021: 12 · 2020: 2
FWCI
2.68
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 1 d)
Locations
  • Ultrasound in Obstetrics and Gynecology (publishedVersion)
  • PubMed (publishedVersion)
  • Cineca Institutional Research Information System (Tor Vergata University) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
Keywords
placenta accreta spectrum, placenta previa, risk factors, placenta increta, placenta percreta, prenatal ultrasound diagnosis, prenatal MRI, placental lacunae, histopathology, diagnostic accuracy, multiparity, cesarean section, curettage, placental insufficiency, placental abruption, fetal growth restriction, preterm birth
MeSH terms
Female, Humans, Magnetic Resonance Imaging, Placenta Accreta, Pregnancy, Prenatal Diagnosis, Risk Factors, Ultrasonography, Prenatal

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