Department of Obstetrics and Gynaecology, Ipswich General Hospital, East Suffolk and North Essex NHS Trust, Ipswich, United Kingdom.
Department of Obstetrics and Gynaecology, West Suffolk Hospital NHS Trust, Bury St Edmunds, United Kingdom.
Am J Obstet Gynecol. 2024 May;230(5):512-531.e3. doi: 10.1016/j.ajog.2023.11.1243. Epub 2023 Nov 25.
This study aimed to analyze and summarize the evidence on the accuracy of different ultrasound methods in the diagnosis of retained products of conception.
We searched Ovid SP, the Cumulative Register to Nursing & Allied Health Literature, EBSCO, and grey literature including Core, Trip, Networked Digital Library of Theses and Dissertations Global ETD search, BMJ Best Practice, PubMed, GreyLit report website (http://www.greylit.org/), Cochrane Central Register of Controlled Trials, and Google scholar (https://scholar.google.com/).
We included prospective and retrospective cross-sectional or Cohort studies that evaluated both ultrasound findings (before management of retained products of conception) and histopathologic results of retained products of conception at all gestational ages.
We used Covidence for data extraction from the studies and quality assessment. The meta-analysis was performed using RevMan 5.4 (forest plot), MetaDTA version 2.01, and Meta-DiSc 2.0 online software.
In total, 11 studies were eligible for data extraction and meta-analysis. The total number of study participants from these 11 studies were 1567. Of these, 9 studies were included to test the accuracy of an echogenic mass, 4 studies analyzed the accuracy of endometrial thickness, and 5 studies analyzed the accuracy of color Doppler flow to predict retained products of conception. We found that echogenic mass had the highest sensitivity, specificity, and diagnostic odds ratio for predicting retained products of conception. The sensitivity, specificity, and diagnostic odds ratio were 0.915 (95% confidence interval, 0.844-0.955), 0.843 (95% confidence interval, 0.615-0.947), and 57.787 (95% confidence interval, 15.171-220.112), respectively. The diagnostic threshold for endometrial thickness was set at 10 mm with a sensitivity, specificity, and diagnostic odds ratio of 0.667 (95% confidence interval, 0.072-0.981), 0.866 (95% confidence interval, 0.375-0.986), and 12.927 (95% confidence interval, 0.23-726.582). The sensitivity, specificity, and diagnostic odds ratio of color Doppler flow were 0.850 (95% confidence interval, 0.756-0.913), 0.406 (95% confidence interval, 0.198-0.655), and 3.893 (95% confidence interval, 1.005-15.081).
Our review concluded that an echogenic mass is the most sensitive and specific predictor of retained products of conception after any pregnancy event. The most important limitation of our review is that the design of the studies included led to significant statistical heterogeneity.
本研究旨在分析和总结不同超声方法在诊断妊娠物残留中的准确性的证据。
我们检索了 Ovid SP、Cumulative Register to Nursing & Allied Health Literature、EBSCO 以及包括 Core、Trip、Networked Digital Library of Theses and Dissertations Global ETD search、BMJ Best Practice、PubMed、GreyLit report 网站（http://www.greylit.org/）、Cochrane 中央对照试验注册库和 Google 学术（https://scholar.google.com/）在内的灰色文献。
我们纳入了评估妊娠物残留的超声表现（在妊娠物残留管理之前）和所有妊娠龄的妊娠物残留组织病理学结果的前瞻性和回顾性横断面或队列研究。
我们使用 Covidence 从研究中提取数据并进行质量评估。使用 RevMan 5.4（森林图）、MetaDTA 版本 2.01 和 Meta-DiSc 2.0 在线软件进行荟萃分析。
共有 11 项研究符合数据提取和荟萃分析的条件。这 11 项研究的总研究参与者人数为 1567 人。其中，9 项研究用于测试回声团的准确性，4 项研究分析子宫内膜厚度的准确性，5 项研究分析彩色多普勒血流预测妊娠物残留的准确性。我们发现，回声团对预测妊娠物残留的敏感性、特异性和诊断比值比最高。其敏感性、特异性和诊断比值比分别为 0.915（95%置信区间，0.844-0.955）、0.843（95%置信区间，0.615-0.947）和 57.787（95%置信区间，15.171-220.112）。子宫内膜厚度的诊断阈值设定为 10mm，其敏感性、特异性和诊断比值比分别为 0.667（95%置信区间，0.072-0.981）、0.866（95%置信区间，0.375-0.986）和 12.927（95%置信区间，0.23-726.582）。彩色多普勒血流的敏感性、特异性和诊断比值比分别为 0.850（95%置信区间，0.756-0.913）、0.406（95%置信区间，0.198-0.655）和 3.893（95%置信区间，1.005-15.081）。
我们的综述得出结论，在任何妊娠事件后，回声团是预测妊娠物残留最敏感和特异的指标。我们综述的一个重要局限性是纳入研究的设计导致了显著的统计学异质性。
