Dataset Information

The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders.

ABSTRACT:

Objective

To assess how a quantifiable measure of vascularity-i.e. abnormal confluence (A_con ) in the subplacental myometrium observed by three-dimensional power-Doppler ultrasonography-changes with different bladder volumes.

Methods

In a prospective observational study, women referred to a tertiary UK center with suspected PAS disorders were recruited between August 2016 and May 2017. The largest area of confluent three-dimensional power-Doppler signal (A_con ) at the uteroplacental interface was estimated under two bladder volumes differing by at least 200 mL.

Results

A_con was calculated for 14 women, of whom seven were subsequently found to have PAS disorders. For these seven women, log(A_con ) was significantly greater when measured with a filled bladder than when measured with an unfilled bladder (P<0.001).

Conclusion

Objective evidence was found for a quantifiable difference in vascularity in the myometrium with bladder volume among women with PAS disorders. This difference has sufficient magnitude to influence the potential of A_con as a diagnostic marker.

SUBMITTER: Maynard H

PROVIDER: S-EPMC6449684 | biostudies-literature | 2018 Mar

REPOSITORIES: biostudies-literature

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Publications

The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders.

Maynard Henry H Zamudio Stacy S Jauniaux Eric E Collins Sally L SL

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 20171126 3

<h4>Objective</h4>To assess how a quantifiable measure of vascularity-i.e. abnormal confluence (A<sub>con</sub> ) in the subplacental myometrium observed by three-dimensional power-Doppler ultrasonography-changes with different bladder volumes.<h4>Methods</h4>In a prospective observational study, women referred to a tertiary UK center with suspected PAS disorders were recruited between August 2016 and May 2017. The largest area of confluent three-dimensional power-Doppler signal (A<sub>con</sub> ...[more]

PMID: 29086915

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Project description:ObjectiveTo assess the performance of the 'separation sign' as a predictor of normal placental separation in a large cohort of women at risk for placenta accreta spectrum (PAS) and in a high-risk subgroup with placenta previa or anterior low-lying placenta and at least one previous Cesarean delivery.MethodsThis was a prospective study of women at risk for PAS referred to a specialist clinic at between 22 and 38 weeks' gestation. All women underwent ultrasound assessment for the presence of the separation sign, which detects the difference in elasticity between the myometrium and the placenta, characterized by different rates of rebound after an ultrasound probe is used to apply pressure over the uteroplacental interface. When the sign is positive, the placenta appears to move relative to the myometrium, leading to the appearance or enhancement of the clear zone. The predictive performance of the separation sign for normal spontaneous placental separation at delivery was assessed.ResultsOf the 194 included women, 163 had a positive separation sign, all of whom went on to have normal placental separation at delivery. Of the 24 women with a negative separation sign, three (12.5%) had normal placental separation and 21 (87.5%) were diagnosed with PAS. This yielded a sensitivity of 98.2% (95% CI, 94.8-99.6%) and specificity of 100% (95% CI, 83.9-100%). In the high-risk cohort (n = 35), a positive separation sign remained a reliable predictor of normal placental separation, with a positive predictive value of 100%, sensitivity of 88.9% (95% CI, 65.3-98.6%) and specificity of 100% (95% CI, 80.5-100%).ConclusionsThe separation sign could be a useful tool in women considered to be at risk for PAS, as it can facilitate the prediction of normal placental separation at delivery. This may prevent overtreatment, the associated iatrogenic morbidity and unnecessary allocation of clinical resources. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Project description:BackgroundMagnetic resonance imaging has been used increasingly as an adjunct for ultrasound imaging for placenta accreta spectrum assessment and preoperative surgical planning, but its value has not been established yet. The ultrasound-based placenta accreta index is a well-validated standardized approach for placenta accreta spectrum evaluation. Placenta accreta spectrum-magnetic resonance imaging markers have been outlined in a joint guideline from the Society of Abdominal Radiology and the European Society of Urogenital Radiology.ObjectiveThis study aimed to compare placenta accreta spectrum-magnetic resonance imaging parameters with the ultrasound-based placenta accreta index in pregnancies at high risk for placenta accreta spectrum and to assess the additional diagnostic value of magnetic resonance imaging for placenta accreta spectrum that requires a cesarean hysterectomy.Study designThis was a single-center, retrospective study of pregnant patients who underwent magnetic resonance imaging, in addition to ultrasonography, because of suspected placenta accreta spectrum. The ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging parameters were obtained. Student's t test and Fisher's exact test were used to compare the groups in terms of the primary outcome (hysterectomy vs no hysterectomy). The diagnostic performance of magnetic resonance imaging and the ultrasound-based placenta accreta index was assessed using multivariable logistic regressions, receiver operating characteristics curves, the DeLong test, McNemar test, and the relative predictive value test.ResultsA total of 82 patients were included in the study, 41 of whom required a hysterectomy. All patients who underwent a hysterectomy met the International Federation of Gynecology and Obstetrics clinical evidence of placenta accreta spectrum at the time of delivery. Multiple parameters of the ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging were able to predict hysterectomy, and the parameter of greatest dimension of invasion by magnetic resonance imaging was the best quantitative predictor. At 96% sensitivity for hysterectomy, the cutoff values were 3.5 for the ultrasound-based placenta accreta index and 2.5 cm for the greatest dimension of invasion by magnetic resonance imaging. Using this sensitivity, the parameter of greatest dimension of invasion measured by magnetic resonance imaging had higher specificity (P=.0016) and a higher positive predictive value (P=.0018) than the ultrasound-based placenta accreta index, indicating an improved diagnostic threshold.ConclusionIn a suspected high-risk group for placenta accreta spectrum, magnetic resonance imaging identified more patients who will not need a hysterectomy than when using the ultrasound-based placenta accrete index only. Magnetic resonance imaging has the potential to aid patient counseling, surgical planning, and delivery timing, including preterm delivery decisions for patients with placenta accreta spectrum requiring hysterectomy.

Project description:ObjectiveTo evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).Data sourcesScreening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.Study eligibility criteriaAll available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.Study appraisal and synthesis methodsExtracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.ResultsThe overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.ConclusionsThe accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.Trial registrationNumber CRD42021267501.

Project description:BackgroundPlacenta 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.MethodsThis 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.ResultsSixteen 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.ConclusionUltrasound 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.

Dataset Information

The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders.

Objective

Methods

Results

Conclusion

Publications

The importance of bladder volume in the ultrasound diagnosis of placenta accreta spectrum disorders.

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