3 years ago

First trimester detection of abnormally invasive placenta in women at risk: a systematic review and meta-analysis

Francesco Forlani, Gabriella Minneci, Ilan E. Timor-Trisch, Marco Liberati, Lamberto Manzoli, Francesca Foti, Danilo Buca, Francesco D'Antonio, Ana Monteagudo, Giuseppe Calì, Josè Palacios-Jaraquemada, Ganesh Acharya
Objectives The primary aim of this systematic review was to ascertain whether ultrasound (US) signs suggestive of abnormally invasive placenta (AIP) are present in the first trimester. The secondary aims were to ascertain the strength of association and the predictive accuracy of such signs in detecting AIP in the first trimester of pregnancy. Methods MEDLINE, EMBASE, CINAHL and Cochrane databases (2000-2016) were searched. Only studies reporting the first trimester diagnosis of AIP that was subsequently confirmed in the third trimester either during operative delivery or by pathology were included. Meta-analysis of proportion, random-effect meta-analysis and hierarchical summary receiver operating characteristic curve (HSROC) analysis were used to compute the data. Results Seven studies (551 pregnancies at risk for AIP) were included. At least one ultrasound sign suggestive of AIP was detected in 91.4% (95% CI 85.8-95.7) of cases with confirmed AIP. The most common ultrasound feature in the first trimester of pregnancy was a low implantation of the gestational sac close to the previous uterine scar which was observed in 82.4% (95% CI 46.6-99.8) of the cases. Anechoic spaces within the placental mass (lacunae) were observed in 46.0% (95% CI 10.9-83.7) and a reduced myometrial thickness in 66.8% (95% CI 45.2-85.2) cases affected by AIP. Pregnancies with a low implantation of the gestational sac had a significantly higher risk of AIP, (OR:19.6, 95% CI 6.7-57.3), with a sensitivity and a specificity of 44.4% (95% CI 21.5-69.2) and 93.4% (95% CI 90.5-95.7) respectively. Conclusions Ultrasound signs of AIP are already present during the first trimester of pregnancy, especially before 11 weeks of gestation. Low anterior implantation of the placenta/sac close to or within the scar was the most common early US signs suggestive of AIP, although its individual predictive accuracy is not high.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18840

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