Effectiveness of Contingent screening for Placenta Accreta Spectrum disorders based on persistent low-lying placenta and previous uterine surgery - 2020
[en] OBJECTIVES: Maternal mortality related to the placenta accreta spectrum (PAS) disorders remain substantial when an unexpected diagnosis is made at delivery. The aim of this study was to evaluate the effectiveness of a routine contingent ultrasound screening program for PAS. METHODS: A retrospective study conducted between 2009 and 2019 involving two groups: a screening cohort of unselected women attending for routine mid-trimester ultrasound assessment and a diagnostic cohort comprised of referrals to the PAS diagnostic service with a suspected diagnosis of PAS in women with placenta previa and previous uterine surgery. Ultrasound assessment by the PAS diagnostic service was comprised of two-dimensional greyscale and color Doppler ultrasonography, and women with a diagnosis of PAS were usually managed with conservative myometrial resection. The final diagnosis of PAS was based on a combination of intraoperative clinical findings and histopathological examination of the surgical specimen. RESULTS: 57,179 women underwent routine mid-trimester fetal anatomy assessment with a third trimester diagnosis of placenta previa in 220 (0.38%). Seventy-five of these women were referred to the PAS diagnostic service because of a history of previous uterine surgery, where 21 of 22 cases of PAS were correctly diagnosed (sensitivity of 95.45%, 95%CI: 77.16-99.88% and specificity of 100%, 95%CI: 99.07-100%). Univariate analysis demonstrated that two or more previous Cesarean sections (OR 94.20, 95%CI 22.00-656.00) and placenta previa (OR 20.50, 95%CI 4.22-369.00) were the strongest risk factors for PAS. In the diagnostic cohort, there were 173 referrals with one false positive and three false negative diagnoses - resulting in a sensitivity 96.63% (95%CI: 90.46-99.30%) and specificity 98.81% (95%CI: 93.54-99.97%). CONCLUSION: A contingent screening strategy for PAS is both feasible and effective in a routine healthcare setting. When linked to a placenta accreta diagnostic and surgical management service, adoption of such a screening strategy has the potential to reduce the maternal morbidity and mortality associated with this condition. Larger prospective studies are necessary before implementing this screening strategy into routine clinical practice. This article is protected by copyright. All rights reserved.
Disciplines :
Médecine de la reproduction (Gynécologie, andrologie, obstétrique)
Auteur, co-auteur :
Coutinho, C. M.
Giorgione, V.
NOEL, Laure ; Centre Hospitalier Universitaire de Liège - CHU > Département de gynécologie-obstétrique > Service de gynécologie-obstétrique (CHR)
Liu, B.
Chandraharan, E.
Pryce, J.
Frick, A. P.
Thilaganathan, B.
Bhide, A.
Langue du document :
Anglais
Titre :
Effectiveness of Contingent screening for Placenta Accreta Spectrum disorders based on persistent low-lying placenta and previous uterine surgery
Date de publication/diffusion :
2020
Titre du périodique :
Ultrasound in Obstetrics and Gynecology
ISSN :
0960-7692
eISSN :
1469-0705
Maison d'édition :
John Wiley & Sons, Hoboken, Etats-Unis - New Jersey
Jauniaux E, Bunce C, Grønbeck L, Langhoff-Roos J. Prevalence and main outcomes of placenta accreta spectrum: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 221: 208–218.
Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: Twenty-year analysis. Am J Obstet Gynecol 2005; 192: 1458–1461.
Morlando M, Sarno L, Napolitano R, Capone A, Tessitore G, Maruotti GM, Martinelli P. Placenta accreta: Incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand 2013; 92: 457–460.
Higgins MF, Monteith C, Foley M, O'Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section. Eur J Obstet Gynecol Reprod Biol 2013; 171: 54–56.
Cheng KKN, Lee MMH. Rising incidence of morbidly adherent placenta and its association with previous caesarean section: A 15-year analysis in a tertiary hospital in Hong Kong. Hong Kong Med J 2015; 21: 511–517.
De Mucio B, Serruya S, Alemán A, Castellano G, Sosa CG. A systematic review and meta-analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. Int J Gynaecol Obstet 2019; 147: 281–291.
Iacovelli A, Liberati M, Khalil A, Timor-Trisch I, Leombroni M, Buca D, Milani M, Flacco ME, Manzoli L, Fanfani F, Calì G, Familiari A, Scambia G, D'Antonio F. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2020; 33: 471–481.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. Incidence and Risk Factors for Placenta Accreta/Increta/Percreta in the UK: A National Case–Control Study. PLoS One 2012; 7: e52893.
Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017; 217: 27–36.
Tinari S, Buca D, Cali G, Timor-Tritsch I, Palacios-Jaraquemada J, Rizzo G, Lucidi A, Di Mascio D, Liberati M, D'Antonio F. Systematic review and meta-analysis of posterior placenta accreta spectrum disorders: risk factors, histopathology and diagnostic accuracy. Ultrasound Obstet Gynecol 2020. DOI: 10.1002/uog.22183.
Green L, Knight M, Seeney FM, Hopkinson C, Collins PW, Collis RE, Simpson N, Weeks A, Stanworth SS. The epidemiology and outcomes of women with postpartum haemorrhage requiring massive transfusion with eight or more units of red cells: a national cross-sectional study. BJOG 2016; 123: 2164–2170.
O'Brien JM, Barton JR, Donaldson ES. The management of placenta percreta: Conservative and operative strategies. Am J Obstet Gynecol 1996; 175: 1632–1638.
Buca D, Liberati M, Calì G, Forlani F, Caisutti C, Flacco ME, Manzoli L, Familiari A, Scambia G, D'Antonio F. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 52: 304–309.
Shamshirsaz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, Ballas J, Chen Q, Van Veen TR, Javadian P, Sangi-Haghpeykar H, Zacharias N, Welty S, Cassady CI, Moaddab A, Popek EJ, Hui SKR, Teruya J, Bandi V, Coburn M, Cunningham T, Martin SR, Belfort MA. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212: 218.e1–9.
Pinas-Carrillo A, Bhide A, Moore J, Hartopp R, Belli AM, Arulkumaran S, Thilaganathan B, Chandraharan E. Outcomes of the first 50 patients with abnormally invasive placenta managed using the “Triple P Procedure” conservative surgical approach. Int J Gynaecol Obstet 2020; 148: 65–71.
Pagani G, Cali G, Acharya G, Trisch IT, Palacios-Jaraquemada J, Familiari A, Buca D, Manzoli L, Flacco ME, Fanfani F, Liberati M, Scambia G, D'antonio F. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2018; 97: 25–37.
Melcer Y, Jauniaux E, Maymon S, Tsviban A, Pekar-Zlotin M, Betser M, Maymon R. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol 2018; 218: 443.e1–443.e8.
Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: A population-based descriptive study. BJOG 2014; 121: 62–71.
Bowman ZS, Eller AG, Kennedy AM, Richards DS, Winter TC 3rd, Woodward PJ, Silver RM. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014; 211: 177.e1–7.
Jauniaux ERM, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, Dornan S, Jurkovic D, Kayem G, Kingdom J, Silver R, Sentilhes L, Royal College of Obstetricians and Gynaecologists. Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green-top Guideline No. 27a. BJOG 2019; 126: e1–e48.
Bhide A, Prefumo F, Moore J, Hollis B, Thilaganathan B. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG 2003; 110: 860–864.
Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S, Duncombe G, Klaritsch P, Chantraine F, Kingdom J, Grønbeck L, Rull K, Nigatu B, Tikkanen M, Sentilhes L, Asatiani T, Leung WC, AIhaidari T, Brennan D, Kondoh E, Yang JI, Seoud M, Jegasothy R, Espino y Sosa S, Jacod B, D'Antonio F, Shah N, Bomba-Opon D, Ayres-de-Campos D, Jeremic K, Kok TL, Soma-Pillay P, Tul Mandić N, Lindqvist P, Arnadottir TB, Hoesli I, Jaisamrarn U, Al Mulla A, Robson S, Cortez R. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet 2018; 140: 274–280.
Bhide A, Laoreti A, Kaelin Agten A, Papageorghiou A, Khalil A, Uprichard J, Thilaganathan B, Chandraharan E. Lower uterine segment placental thickness in women with abnormally invasive placenta. Acta Obstet Gynecol Scand 2019; 98: 95–100.
di Pasquo E, Ghi T, Calì G, D'Antonio F, Fratelli N, Forlani F, Prefumo F, Kaihura CT, Volpe N, Dall'Asta A, Frusca T. Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. Ultrasound Obstet Gynecol 2020; 55: 460–466.
Cali G, Forlani F, Lees C, Timor-Tritsch I, Palacios-Jaraquemada J, Dall'Asta A, Bhide A, Flacco ME, Manzoli L, Labate F, Perino A, Scambia G, D'Antonio F. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound Obstet Gynecol 2019; 53: 752–760.
Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018; 218: 75–87.
Chandraharan E, Rao S, Belli AM, Arulkumaran S. The Triple-P procedure as a conservative surgical alternative to peripartum hysterectomy for placenta percreta. Int J Gynaecol Obstet 2012; 117: 191–194.
Sentilhes L, Kayem G, Chandraharan E, Palacios-Jaraquemada J, Jauniaux E, Duncombe G, Klaritsch P, Chantraine F, Kingdom J, Grønbeck L, Rull K, Nigatu B, Tikkanen M, Sentilhes L, Asatiani T, Leung WC, AIhaidari T, Brennan D, Kondoh E, Yang JI, Seoud M, Jegasothy R, Espino y Sosa S, Jacod B, D'Antonio F, Shah N, Bomba-Opon D, Ayres-de-Campos D, Jeremic K, Kok TL, Soma-Pillay P, Tul Mandić N, Lindqvist P, Arnadottir TB, Hoesli I, Jaisamrarn U, Al Mulla A, Robson S, Cortez R. FIGO consensus guidelines on placenta accreta spectrum disorders: Conservative management. Int J Gynaecol Obstet 2018; 140: 291–298.
Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J, Fox KA, Collins S, Duncombe G, Klaritsch P, Chantraine F, Kingdom J, Grønbeck L, Rull K, Tikkanen M, Sentilhes L, Asatiani T, Leung WC, AIhaidari T, Brennan D, Seoud M, Hussein AM, Jegasothy R, Shah KN, Bomba-Opon D, Hubinont C, Soma-Pillay P, Mandić NT, Lindqvist P, Arnadottir B, Hoesli I, Cortez R. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146: 20–24.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007; 370: 1453–1457.
Jauniaux E, Grønbeck L, Bunce C, Langhoff-Roos J, Collins SL. Epidemiology of placenta previa accreta: A systematic review and meta-analysis. BMJ Open 2019; 9: 1–9.
Gyamfi-Bannerman C, Gilbert S, Landon MB, Spong CY, Rouse DJ, Varner MW, Caritis SN, Meis PJ, Wapner RJ, Sorokin Y, Carpenter M, Peaceman AM, O'Sullivan MJ, Sibai BM, Thorp JM, Ramin SM, Mercer BM. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol 2012; 120: 1332–1337.
Baldwin HJ, Patterson JA, Nippita TA, Torvaldsen S, Ibiebele I, Simpson JM, Ford JB. Antecedents of abnormally invasive placenta in primiparous women: Risk associated with gynecologic procedures. Obstet Gynecol 2018; 131: 227–233.
Carusi DA. The placenta accreta spectrum: Epidemiology and risk factors. Clin Obstet Gynecol 2018; 61: 733–742.
Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019; 53: 101–106.
Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Neonatal Med 2011; 24: 1341–1346.
Chandraharan E, Hartopp R, Thilaganathan B, Coutinho CM. How to set up a regional specialist referral service for Placenta Accreta Spectrum (PAS) disorders? Best Pract Res Clin Obstet Gynaecol 2020. DOI: 10.1016/j.bpobgyn.2020.07.007.
