Bartels Helena C, Walsh Jennifer M, Carroll Stephen, Downey Paul, O'Brien Donal J, McAuliffe Fionnuala M, C'Connor Clare, Thompson Claire, Donnelly Jennifer, Brennan Donal J, Corcoran Siobhan M
Department of Fetal Medicine, National Maternity Hospital, Dublin, Ireland.
Department of UCD Obstetrics and Gynaecology, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.
Acta Obstet Gynecol Scand. 2025 Apr;104 Suppl 1(Suppl 1):56-65. doi: 10.1111/aogs.14943. Epub 2024 Oct 2.
The European Working Group for Abnormally Invasive Placenta proposed a checklist of ultrasound features for the antenatal detection of placenta accreta spectrum (PAS). This study aims to assess the performance of the checklist in identifying histopathologically confirmed PAS cases in a cohort with a high pre-test probability of PAS, and identify if particular features are associated with PAS.
This is a prospective multi-site cohort study conducted between 2018 and 2023. Consecutive patients who underwent ultrasound assessment for suspicion of PAS were included, and the sonographic checklist was completed at the time of ultrasound. Cases were defined as PAS where they had intraoperative findings as described by the International Federation of Gynecology and Obstetrics (FIGO) grading, and histopathological findings for hysterectomy and myometrial resection cases. All non-PAS cases in this study had placenta previa and at least one prior cesarean delivery.
Seventy-eight participants met inclusion criteria, of whom 63 (80.7%) were diagnosed with PAS. Cesarean hysterectomy was performed in 49 cases (62.8%). Overall, third-trimester ultrasound performed at a median gestational age of 32 weeks (IQR 30-34 weeks) had a sensitivity of 0.84 (95% CI 0.73 to 0.92) and specificity of 0.73 (95% CI 0.45 to 0.92) for detecting PAS, with a positive and negative likelihood ratio of 3.15 (95% CI 1.35 to 7.35) and 0.22 (95% CI 0.11 to 0.41), respectively. Features most associated with PAS were abnormal placental lacunae (Odds Ratio [OR] 5.40 [95% CI 1.61 to 18.03] and myometrial thinning OR 6.87 [95% CI 1.93 to 24.4]). While many of the ultrasound features seen in PAS were also present in cases of placenta previa with prior Cesarean section, the median (IQR) number of features present in PAS cases was significantly higher than in the non-PAS placenta previa group (six features [3-8] vs. two features [0-3] p = 0.001). No case of non-PAS placenta previa had more than five features present.
The use of a standardized sonographic checklist had a high sensitivity and good specificity for the detection of PAS in this prospective cohort of well-classified PAS cases.
欧洲异常侵袭性胎盘工作组提出了一份超声特征清单，用于产前检测胎盘植入谱系疾病（PAS）。本研究旨在评估该清单在识别PAS预测试概率较高的队列中经组织病理学确诊的PAS病例方面的性能，并确定特定特征是否与PAS相关。
这是一项于2018年至2023年进行的前瞻性多中心队列研究。纳入了因怀疑PAS而接受超声评估的连续患者，并在超声检查时完成了超声检查清单。病例定义为符合国际妇产科联合会（FIGO）分级描述的术中发现以及子宫切除术和子宫肌层切除术病例的组织病理学发现的PAS。本研究中的所有非PAS病例均为前置胎盘且至少有一次既往剖宫产史。
78名参与者符合纳入标准，其中63例（80.7%）被诊断为PAS。49例（62.8%）进行了剖宫产子宫切除术。总体而言，孕晚期超声检查的中位孕周为32周（四分位间距30 - 34周），检测PAS的灵敏度为0.84（95%置信区间0.73至0.92），特异度为0.73（95%置信区间0.45至0.92），阳性似然比为3.15（95%置信区间1.35至7.35），阴性似然比为0.22（95%置信区间0.11至0.41）。与PAS最相关的特征是胎盘腔异常（优势比[OR] 5.40 [95%置信区间1.61至18.03]）和子宫肌层变薄（OR 6.87 [95%置信区间1.93至24.4]）。虽然PAS中出现的许多超声特征在有既往剖宫产史的前置胎盘病例中也存在，但PAS病例中出现的特征的中位（四分位间距）数量显著高于非PAS前置胎盘组（六个特征[3 - 8]对两个特征[0 - 3]，p = 0.001）。没有非PAS前置胎盘病例出现超过五个特征。
在这个前瞻性队列中，对于分类明确的PAS病例，使用标准化超声检查清单检测PAS具有高灵敏度和良好的特异度。
