Mohamed Ekramy A, Ahmed Ruqayyah Ali, Metwali Nada Yasser, Timraz Jumana Hussain, Mohamed Ahmed, Mansour Hossam Abdelfatah
Department of Obstetrics and Gynecology, Zagazig University Hospital ZUH, Zagazig, Egypt (Mohamed).
Department of General Medicine and Surgery, Batterjee Medical College for Science and Technology, Jeddah, Saudi Arabia (Ahmed, Metwali, and Timraz).
AJOG Glob Rep. 2025 Feb 24;5(2):100467. doi: 10.1016/j.xagr.2025.100467. eCollection 2025 May.
The accuracy of ultrasound in detecting invasive placentation, such as placenta accreta spectrum (PAS), remains a topic of debate. Accurate prenatal diagnosis is crucial to improve maternal outcomes, especially in women with high-risk factors..
This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of ultrasonography in predicting invasive placentation among at-risk pregnant women.
A comprehensive search of multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) was conducted to identify studies assessing the diagnostic accuracy of ultrasound in detecting PAS. A total of 24 studies, including 1,509 high-risk pregnancies, met the inclusion criteria. Data on sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were extracted and analyzed.
The meta-analysis demonstrated that ultrasound has a high diagnostic performance, with a pooled sensitivity of 91.73% (95% CI: 88.3-94.7%) and specificity of 97.95% (95% CI: 97.4-98.6%). The DOR was 99.6 (95% CI: 49.9-200.1). Among ultrasound modalities, color Doppler showed the highest predictive accuracy with a sensitivity of 91.75% (95% CI: 86.3-95.6%) and specificity of 87.69% (95% CI: 85.7-91.5%).
Ultrasound, especially with the use of color Doppler, is highly effective in the prenatal diagnosis of PAS disorders in high-risk pregnancies. Early detection through ultrasound allows for better clinical management, reducing maternal morbidity by enabling planned interventions.
超声检测侵袭性胎盘植入（如胎盘植入谱系疾病，PAS）的准确性仍是一个有争议的话题。准确的产前诊断对于改善孕产妇结局至关重要，尤其是对于有高危因素的女性。
本系统评价和荟萃分析旨在评估超声在预测高危孕妇侵袭性胎盘植入方面的诊断准确性。
对多个数据库（MEDLINE、EMBASE、Cochrane图书馆等）进行全面检索，以确定评估超声检测PAS诊断准确性的研究。共有24项研究，包括1509例高危妊娠，符合纳入标准。提取并分析了敏感性、特异性、阳性似然比（LR+）、阴性似然比（LR-）和诊断比值比（DOR）的数据。
荟萃分析表明，超声具有较高的诊断性能，汇总敏感性为91.73%（95%CI：88.3-94.7%），特异性为97.95%（95%CI：97.4-98.6%）。DOR为99.6（95%CI：49.9-200.1）。在超声检查方式中，彩色多普勒显示出最高的预测准确性，敏感性为91.75%（95%CI：86.3-95.6%），特异性为87.69%（95%CI：85.7-91.5%）。
超声，尤其是使用彩色多普勒，在高危妊娠PAS疾病的产前诊断中非常有效。通过超声早期检测有助于更好的临床管理，通过实施计划性干预降低孕产妇发病率。
