Peng Xue, Tan Xi, Wu Zhao
Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, 610041, China.
BMC Pregnancy Childbirth. 2024 Dec 21;24(1):846. doi: 10.1186/s12884-024-07076-9.
Placenta accreta spectrum (PAS) is one of the most dangerous pregnancy-related conditions. This study aims to conduct a systematic review of current research on the ultrasound scoring systems used in PAS patients with a comprehensive summarization of researches and comparison of prenatal ultrasound scoring in evaluating postpartum outcomes.
This systematic review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were retrieved from four databases (PubMed, Cochrane Library, Embase and Web of Science) up to December 2023. Original studies involving women diagnosed with PAS using ultrasound scoring for diagnosis or outcome evaluation were screened based on predefined inclusion and exclusion criteria. The primary outcome was the diagnostic performance of ultrasound scoring systems and their effectiveness in predicting labor outcomes. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was utilized to assess the study quality. The study has been registered on the PROSPERO website with the registration number CRD42024507311.
Sixteen studies met the inclusion criteria. 3930 patients were included in the review, with 1693 participants in the control group. Included studies had a high risk of bias in patient selection, with a low risk in flow and timing and reference standards. Existing studies have reported several indicators that can be included in ultrasound scoring systems and tested their effectiveness in diagnosis and severity evaluation. The pool sensitivity, specificity, and area under the curve (AUC) of ultrasound scoring system in diagnosing PAS were 0.89 (95% confidence interval [CI]: 0.82-0.94), 0.85(95%CI: 0.80-0.90) and 0.93 (95%CI:0.91-0.95). Ultrasound scores are associated with PAS outcomes including intraoperative haemorrhage, postpartum haemorrhage, hysterectomy, length of hospital stay, and neonatal prognosis. Limitation is that the existing studies are wide-ranging but have low replication and association.
Ultrasound scoring systems play a role in the prenatal diagnosis, management, and prediction of postnatal complications in PAS. Nevertheless, additional research is required to further evaluate the performance between different scoring systems to develop a unified consensus.
胎盘植入谱系疾病（PAS）是最危险的妊娠相关疾病之一。本研究旨在对目前用于PAS患者的超声评分系统的研究进行系统综述，全面总结研究情况，并比较产前超声评分在评估产后结局方面的作用。
本系统综述按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行实施和报告。截至2023年12月，从四个数据库（PubMed、Cochrane图书馆、Embase和科学网）检索研究。根据预先定义的纳入和排除标准，筛选涉及使用超声评分诊断或评估结局的被诊断为PAS的女性的原始研究。主要结局是超声评分系统的诊断性能及其预测分娩结局的有效性。使用诊断准确性研究质量评估-2（QUADAS-2）工具评估研究质量。该研究已在PROSPERO网站注册，注册号为CRD42024507311。
16项研究符合纳入标准。本综述纳入3930例患者，其中1693例为对照组参与者。纳入的研究在患者选择方面存在较高的偏倚风险，在流程、时间和参考标准方面风险较低。现有研究报告了一些可纳入超声评分系统的指标，并测试了其在诊断和严重程度评估中的有效性。超声评分系统诊断PAS的合并敏感性、特异性和曲线下面积（AUC）分别为0.89（95%置信区间[CI]：0.82-0.94）、0.85（95%CI：(0.80-0.90)）和0.93（95%CI：0.91-0.95）。超声评分与PAS结局相关，包括术中出血、产后出血、子宫切除术、住院时间和新生儿预后。局限性在于现有研究范围广泛，但重复性和关联性较低。
超声评分系统在PAS的产前诊断、管理和产后并发症预测中发挥作用。然而，需要进一步研究以进一步评估不同评分系统之间的性能，从而形成统一的共识。
