Department of Obstetrics and Gynecology, Kasr Al-Ainy Hospital, Cairo University, Giza, Egypt.
Department of Obstetrics and Gynecology, Beni-Suef University, Beni-Suef, Egypt.
BMC Pregnancy Childbirth. 2023 May 15;23(1):354. doi: 10.1186/s12884-023-05675-6.
To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).
Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.
All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.
Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.
The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.
The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.
Number CRD42021267501.
评估超声在胎盘植入谱系疾病（PAS）诊断中的诊断准确性。
使用与胎盘植入、植入、穿透性胎盘、粘连性胎盘和术前超声诊断相关的关键词，对 MEDLINE、CENTRAL 等数据库进行了从创建到 2022 年 2 月的筛选。
所有可用的研究，无论前瞻性还是回顾性，包括队列研究、病例对照研究和横断面研究，均包括使用二维或三维超声进行 PAS 的产前诊断，随后进行产后病理证实。共有 54 项研究纳入了 5307 名女性，符合纳入标准，其中 2025 名女性 PAS 得到证实。
提取的数据包括研究地点、研究类型、样本量、参与者特征及其纳入和排除标准、胎盘前置的类型和部位、影像学技术的类型和时间（二维和三维）、PAS 的严重程度、个别超声标准的敏感性和特异性以及总体敏感性和特异性。
总体敏感性为 0.8703，特异性为 0.8634，两者之间存在-0.2348 的负相关。估计的比值比、负似然比和正似然比分别为 34.225、0.155 和 4.990。估计的失 retroplacental 清晰带的敏感性和特异性分别为 0.820 和 0.898，两者之间存在 0.129 的负相关。估计的肌层变薄、失 retroplacental 清晰带、存在桥接血管、胎盘陷窝、膀胱壁中断、外生肿块和子宫-膀胱高血管性的敏感性分别为 0.763、0.780、0.659、0.785、0.455、0.218 和 0.513，特异性分别为 0.890、0.884、0.928、0.809、0.975、0.865 和 0.994。
对于有低位或剖宫产史胎盘前置的妇女，超声在 PAS 诊断中的准确性较高，建议在所有疑似病例中使用。
编号 CRD42021267501。
