Givens Matthew, Valcheva Ivaila, Einerson Brett D, Rogozińska Ewelina, Jauniaux Eric
Department of Obstetrics and Gynecology (Drs Givens and Einerson), University of Utah Health (UUH), Salt Lake City, Utah, USA.
EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK.
Acta Obstet Gynecol Scand. 2024 Dec;103(12):2335-2347. doi: 10.1111/aogs.14918. Epub 2024 Jul 14.
Placenta accreta spectrum (PAS) is an increasingly commonly reported condition due to the continuous increase in the rate of cesarean deliveries (CD) worldwide; however, the prenatal screening for pregnant patients at risk of PAS at birth remains limited, in particular when imaging expertise is not available.
Two major electronic databases (MEDLINE and Embase) were searched electronically for articles published in English between October 1992 and January 2023 using combinations of the relevant medical subject heading terms and keywords. Two independent reviewers selected observational studies that provided data on one or more measurement of maternal blood-specific biomarker(s) during pregnancies with PAS at birth. PRISMA Extension for Scoping Review (PRISMA-ScR) was used to extract data and report results.
Of the 441 reviewed articles, 29 met the inclusion criteria reporting on 34 different biomarkers. 14 studies were retrospective and 15 prospective overall including 18 251 participants. Six studies had a cohort design and the remaining a case-control design. Wide clinical heterogeneity was found in the included studies. In eight studies, the samples were obtained in the first trimester; in five, the samples were collected on hospital admission for delivery; and in the rest, the samples were collected during the second and/or third trimester.
Measurements of serum biomarkers, some of which have been or are still used in screening for other pregnancy complications, could contribute to the prenatal evaluation of patients at risk of PAS at delivery; however, important evidence gaps were identified for suitable cutoffs for most biomarkers, variability of gestational age at sampling and the potential overlap of the marker values with other placental-related complications of pregnancy.
由于全球剖宫产率持续上升，胎盘植入谱系疾病（PAS）的报告越来越常见；然而，对有PAS出生风险的孕妇进行产前筛查仍然有限，特别是在缺乏影像专业知识的情况下。
通过电子方式检索两个主要电子数据库（MEDLINE和Embase），以查找1992年10月至2023年1月期间以英文发表的文章，使用相关医学主题词和关键词的组合。两名独立评审员选择了观察性研究，这些研究提供了在出生时患有PAS的妊娠期间母体血液特异性生物标志物一项或多项测量的数据。采用PRISMA范围综述扩展版（PRISMA-ScR）提取数据并报告结果。
在441篇综述文章中，29篇符合纳入标准，报告了34种不同的生物标志物。14项研究为回顾性研究，15项为前瞻性研究，总共包括18251名参与者。6项研究采用队列设计，其余采用病例对照设计。纳入研究中发现了广泛的临床异质性。在8项研究中，样本在孕早期采集；在5项研究中，样本在入院分娩时采集；其余的样本在孕中期和/或孕晚期采集。
血清生物标志物的测量，其中一些已经或仍用于筛查其他妊娠并发症，可能有助于对分娩时有PAS风险的患者进行产前评估；然而，对于大多数生物标志物的合适临界值、采样时的孕周变异性以及标志物值与其他胎盘相关妊娠并发症的潜在重叠，发现了重要的证据空白。
