病理性诊断为胎盘植入谱系疾病而无前置胎盘：系统评价和荟萃分析。
Pathologically diagnosed placenta accreta spectrum without placenta previa: a systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
出版信息
Am J Obstet Gynecol MFM. 2023 Aug;5(8):101027. doi: 10.1016/j.ajogmf.2023.101027. Epub 2023 May 19.
OBJECTIVE
This systematic review and meta-analysis aimed to assess clinical characteristics related to pathologically proven placenta accreta spectrum without placenta previa.
DATA SOURCES
A literature search of PubMed, the Cochrane database, and Web of Science was performed from inception to September 7, 2022.
STUDY ELIGIBILITY CRITERIA
The primary outcomes were invasive placenta (including increta or percreta), blood loss, hysterectomy, and antenatal diagnosis. In addition, maternal age, assisted reproductive technology, previous cesarean delivery, and previous uterine procedures were investigated as potential risk factors. The inclusion criteria were studies evaluating the clinical presentation of pathologically diagnosed PAS without placenta previa.
METHODS
Study screening was conducted after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis.
RESULTS
Among 2598 studies that were initially retrieved, 5 were included in the review. With the exception of 1 study, 4 studies were included in the meta-analysis. This meta-analysis showed that placenta accreta spectrum without placenta previa was associated with less risk of invasive placenta (odds ratio, 0.24; 95% confidence interval, 0.16-0.37), blood loss (mean difference, -1.19; 95% confidence interval, -2.09 to -0.28) and hysterectomy (odds ratio, 0.11; 95% confidence interval, 0.02-0.53), and more difficult to diagnose prenatally (odds ratio, 0.13; 95% confidence interval, 0.04-0.45) than placenta accreta spectrum with placenta previa. In addition, assisted reproductive technology and a previous uterine procedure were strong risk factors for placenta accreta spectrum without placenta previa, whhereas previous cesarean delivery was a strong risk factor for placenta accreta spectrum with placenta previa.
CONCLUSION
The differences in clinical aspects of placenta accreta spectrum with and without placenta previa need to be understood.
目的
本系统评价和荟萃分析旨在评估无前置胎盘的病理性胎盘植入谱系疾病的临床特征。
资料来源
从建库至 2022 年 9 月 7 日，对 PubMed、Cochrane 数据库和 Web of Science 进行了文献检索。
研究入选标准
主要结局指标为侵袭性胎盘（包括植入或穿透性胎盘）、出血量、子宫切除术和产前诊断。此外，还研究了产妇年龄、辅助生殖技术、既往剖宫产术和既往子宫操作作为潜在的危险因素。纳入标准为评估病理性诊断为 PAS 而无前置胎盘的临床表现的研究。
方法
在识别并去除重复内容后，进行研究筛选。评估了每个研究的质量和发表偏倚。对于每组的每个研究结果，计算了森林图和 I 统计量。主要分析为随机效应分析。
结果
在最初检索到的 2598 项研究中，有 5 项研究被纳入综述。除了 1 项研究外，其余 4 项研究都被纳入了荟萃分析。这项荟萃分析表明，无前置胎盘的胎盘植入谱系疾病与侵袭性胎盘（优势比，0.24；95%置信区间，0.16-0.37）、出血量（平均差异，-1.19；95%置信区间，-2.09 至-0.28）和子宫切除术（优势比，0.11；95%置信区间，0.02-0.53）的风险降低有关，并且产前诊断更困难（优势比，0.13；95%置信区间，0.04-0.45），而有前置胎盘的胎盘植入谱系疾病的风险增加。此外，辅助生殖技术和既往子宫操作是无前置胎盘的胎盘植入谱系疾病的强烈危险因素，而前置胎盘是有前置胎盘的胎盘植入谱系疾病的强烈危险因素。
结论
需要了解有无前置胎盘的胎盘植入谱系疾病的临床方面的差异。
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