Delphi survey; placenta accreta spectrum; placenta previa accreta; systematic review; ultrasound imaging; Infant, Newborn; Pregnancy; Female; Humans; Placenta/diagnostic imaging; Delphi Technique; Ultrasonography; Ultrasonography, Prenatal; Retrospective Studies; Placenta Accreta/diagnostic imaging; Placenta Previa; Placenta; Placenta Accreta; Radiological and Ultrasound Technology; Reproductive Medicine; Radiology, Nuclear Medicine and Imaging; Obstetrics and Gynecology; General Medicine
Abstract :
[en] [en] OBJECTIVE: To determine, by expert consensus through a modified Delphi process, the role of standardized and new ultrasound signs in the prenatal evaluation of patients at high risk of placenta accreta spectrum (PAS).
METHODS: A systematic review of articles providing information on ultrasound imaging signs or markers associated with PAS was performed before the development of questionnaires for the first round of the Delphi process. Only peer-reviewed original research studies in the English language describing one or more new ultrasound sign(s) for the prenatal evaluation of PAS were included. A three-round consensus-building Delphi method was then conducted under the guidance of a steering group, which included nine experts who invited an international panel of experts in obstetric ultrasound imaging in the evaluation of patients at high risk for PAS. Consensus was defined as agreement of ≥ 70% between participants.
RESULTS: The systematic review identified 15 articles describing eight new ultrasound signs for the prenatal evaluation of PAS. A total of 35 external experts were approached, of whom 31 agreed and participated in the first round. Thirty external experts (97%) and seven experts from the steering group completed all three Delphi rounds. A consensus was reached that a prior history of at least one Cesarean delivery, myomectomy or PAS should be an indication for detailed PAS ultrasound assessment. The panelists also reached a consensus that seven of the 11 conventional signs of PAS should be included in the examination of high-risk patients and the routine mid-gestation scan report: (1) loss of the 'clear zone', (2) myometrial thinning, (3) bladder-wall interruption, (4) placental bulge, (5) uterovesical hypervascularity, (6) placental lacunae and (7) bridging vessels. A consensus was not reached for any of the eight new signs identified by the systematic review. With respect to other ultrasound features that are not specific to PAS but increase the probability of PAS at birth, the panelists reached a consensus for the finding of anterior placenta previa or placenta previa with cervical involvement. The experts were also asked to determine which PAS signs should be quantified and consensus was reached only for the quantification of placental lacunae using an existing score. For predicting surgical outcome in patients with a high probability of PAS at delivery, a consensus was obtained for loss of the clear zone, bladder-wall interruption, presence of placental lacunae and presence of placenta previa involving the cervix.
CONCLUSIONS: We have confirmed the continued importance of seven established standardized ultrasound signs of PAS, highlighted the role of transvaginal ultrasound in evaluating the placental position and anatomy of the cervix, and identified new ultrasound signs that may become useful in the future prenatal evaluation and management of patients at high risk for PAS at birth.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Jauniaux, E ; EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
D'Antonio, F; Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University of Chieti, Italy
Bhide, A ; Fetal Medicine Unit, Department of Obstetrics and Gynaecology, St George's Hospital, London, UK
Prefumo, F ; Obstetrics and Gynaecology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
Silver, R M; Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City, UT, USA
Hussein, A M; Department of Obstetrics and Gynecology, University of Cairo, Cairo, Egypt
Shainker, S A; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Chantraine, Frédéric ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Alfirevic, Z; Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
Delphi consensus expert panel
Language :
English
Title :
Modified Delphi study of ultrasound signs associated with placenta accreta spectrum.
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