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.
Am J Obstet Gynecol MFM. 2023 Dec;5(12):101197. doi: 10.1016/j.ajogmf.2023.101197. Epub 2023 Oct 20.
This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum.
A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022.
Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa.
Study screening was performed 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.
Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21-0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02-3.83), lower blood loss volume (mean difference, -0.65; 95% confidence interval, -1.17 to -0.13), and lower number of transfused red blood cell units (mean difference, -1.96; 95% confidence interval, -3.25 to -0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10-0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12-11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06-0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24-7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12-11.25) showed statistical significance. No significant difference was found for the other outcomes.
Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.
本研究旨在比较产前和非产前诊断的胎盘植入谱系不良结局。
系统检索了 PubMed、Cochrane 数据库和 Web of Science 数据库，检索时间截至 2022 年 11 月 28 日。
纳入比较产前和非产前诊断的胎盘植入谱系不良临床表现的研究。主要结局指标为紧急剖宫产、子宫切除术、失血量、输血量、泌尿道损伤、凝血功能障碍、再次手术、重症监护病房入院和产妇死亡。此外，还计算了失血量和输血量的汇总平均值。次要结局指标包括产妇年龄、分娩时的胎龄、初产妇、既往剖宫产史、既往子宫手术史、辅助生殖技术、胎盘植入和穿透性胎盘、胎盘前置。
识别并去除重复项后进行研究筛选。评估了每项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。
共评估了 415 篇摘要和 157 篇全文研究，其中 31 项研究被分析。与非产前诊断的胎盘植入谱系不良相比，产前诊断的胎盘植入谱系不良与较低的紧急剖宫产率（比值比，0.37；95%置信区间，0.21-0.67）、较高的子宫切除术率（比值比，1.98；95%置信区间，1.02-3.83）、较低的失血量（平均差值，-0.65；95%置信区间，-1.17 至-0.13）和较低的输血量（平均差值，-1.96；95%置信区间，-3.25 至-0.68）相关。与非产前诊断的胎盘植入谱系不良相比，产前诊断的胎盘植入谱系不良的失血量和输血量的汇总平均值也较低。初产妇（比值比，0.14；95%置信区间，0.10-0.20）、既往剖宫产史（比值比，6.81；95%置信区间，4.12-11.25）、辅助生殖技术（比值比，0.19；95%置信区间，0.06-0.61）、胎盘植入和穿透性胎盘（比值比，3.97；95%置信区间，2.24-7.03）和胎盘前置（比值比，6.81；95%置信区间，4.12-11.25）具有统计学意义。其他结局无显著差异。
尽管严重程度较高，但产前诊断的胎盘植入谱系不良对结局的积极影响强调了产前诊断的必要性。此外，汇总平均值提供了术前准备指南。
