Diagnostic value of early echography in pregnant women at risk for placenta accreta


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Abstract

Objective: To study the diagnostic value of ultrasound assessment at 5-10 weeks gestation in women with risk factors for placenta accreta spectrum (PAS). Materials and methods: This was a retrospective analysis of the data of 181 women. Inclusion criterion was the presence of uterine scar. The ultrasound assessment was performed at 5-10 weeks gestation, the women gave birth at Regional Clinical Hospital No. 2, Krasnodar, Russia from 2017 to 2019. We studied the relationship between PAS and potential predictors, including ultrasound signs (low position of the gestational sac in the uterine cavity; implantation of the gestational sac in the scar; hypervascular pattern at the implantation site; bulge of the uterine wall at the implantation site; subchorionic hematoma) and maternal clinical and demographic parameters (age, parity, number of cesarean sections and other surgeries of the uterus). Results: Diagnostic significance for the prediction of PAS in pregnant women was revealed for cesarean section in history (0R=2.30; 95% CI: 1.50-3.53, p<0.001), low position of gestational sac (0R=17.70; 95% CI: 5.8753.40, p<0.001); increase in the number of ultrasound signs (+1) (0R=7.37; 95% CI: 3.74-14.53, р<0.001). The absence of ultrasound signs had 0R=0.102; 95% CI: 0.049-0.21, p<0.001. Parity and hematoma in the uterine cavity had significant differences only for invasive forms of PAS (increta, percreta). According to ultrasound data at 5-10 weeks gestation, a low position of the gestational sac in combination with the presence of a hematoma in the uterine cavity is suggestive of PAS in pregnant patients with >1 scar after cesarean section with Se=61.11 (95% CI: 48.89-72.38); Sp=88.07(95% CI: 80.47-93.49);LR(+)=5.12(95% CI: 2.98-8.81); LR(-)=0.44(95% CI: 0.33-0.59); PPV=98.98(95% CI: 98.26-99.41); NPV=10.65(95% CI: 8.13-13.83). Conclusion: Ultrasound assessment at an early stage of pregnancy can be used for selective screening of PAS.

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About the authors

Tatiana B. Makukhina

Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar Territory; Kuban State Medical University, Ministry of Health of Russia

Email: soltamna@mam.ru
PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Advanced Training and Professional Retraining of Specialists

Grigoriy A. Penzhoyan

Regional Clinical Hospital No. 2, Ministry of Health of the Krasnodar Territory; Kuban State Medical University, Ministry of Health of Russia

Email: pga05@mail.ru
Dr. Med. Sci., Professor, Head of the Department of Obstetrics, Gynecology and Perinatology, Faculty of Advanced Training and Professional Retraining of Specialists

Maria V. Dontsova

Kuban State University, Ministry of Science and Higher Education of the Russian Federation

PhD (sociological sciences), Associate Professor, Associate Professor at the Department of Sociology

Natalia V. Krivonosova

Kuban State Medical University, Ministry of Health of Russia

PhD, Associate Professor, Associate Professor of the Department of Obstetrics, Gynecology and Perinatology Faculty of Advanced Training and Professional Retraining of Specialists

References

  1. Баринов С.В., Медянникова И.В., Тирская Ю.И., Безнощенко Г.Б., Кадцына Т.В., Лазарева О.В., Биндюк А.В., Неустроева Т.Н., Степанов С.С. Прогнозирование приращения плаценты при ее предлежании. Акушерство и гинекология. 2021; 1: 61-9. https://dx.doi.org/10.18565/aig.2021.1.61-69.
  2. Курцер М.А., Григорьян А.М. Временная баллонная окклюзия при врастании плаценты. Эндоваскулярная хирургия. 2020; 7(2): 113-22. https://dx.doi.org/10.24183/2409-4080-2020-7-2-113-122.
  3. Лисицына О.И., Низяева Н.В., Михеева А.А. Врастание плаценты. Эволюция знаний и умений. Акушерство и гинекология. 2021; 6: 34-40. [Lisitsyna O.I., Nizyaeva N.V., Mikheeva A.A. Placenta accreta. Evolution of knowledge and skills. Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2021; 6: 34-40. (in Russian)]. https://dx.doi.org/10.18565/aig.2021.6.34-40.
  4. Пенжоян Г.А. Служба родовспоможения в крупном городе. Проблемы социальной гигиены, здравоохранения и истории медицины. 2003; 3: 37.
  5. Пенжоян Г.А. Эффективность современных перинатальных технологий. Проблемы социальной гигиены, здравоохранения и истории медицины. 2002; 6: 42.
  6. Марченко Р.Н., Кукарекая И.И., Ербактанова Т.А. Эффективность эмболизации маточных артерий у пациенток с приращением плаценты. Consilium Medicum. 2020; 22(6): 25-7. https://dx.doi.org/10.26442/20751753.2020.6.200303.
  7. Министерство здравоохранения Российской Федерации. Приказ «Об утверждении Порядка оказания медицинской помощи по профилю "акушерство и гинекология"» от 20.10.2020 №1130н (зарегистрирован 12.11.2020 №60869).
  8. Гус А.И., Бойкова Ю.В., Ярыгина Т.А., Яроцкая Е.Л. Современные подходы к пренатальной диагностике и скринингу врастания плаценты (обзор рекомендаций). Акушерство и гинекология. 2020; 10: 5-12. [Gus A.I., Boykova Yu.V., Yarygina T.A., Yarotskaya E.L. Modern approaches to prenatal diagnosis and screening of placenta accreta (review of recommendations). Akusherstvo i ginekologiya/Obstetrics and Gynecology. 2020; 10: 5-12. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.5-12.
  9. Kaelin Agten A., Cali G., Monteagudo A., Oviedo J., Ramos J., Timor-Tritsch I. The clinical outcome of cesarean scar pregnancies implanted "on the scar" versus "in the niche". Am. J. Obstet. Gynecol. 2017; 216(5): 510.e1-510.e6. https://dx.doi.org/10.1016/j.ajog.2017.01.019.
  10. DAntonio F., Timor-Tritsch I.E., Palacios-Jaraquemada J., Monteagudo A., Buca D., Forlani F. et al. First-trimester detection of abnormally invasive placenta in high-risk women: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2018; 51(2): 176-83. https://dx.doi.org/10.1002/uog.18840.
  11. Timor-Tritsch I.E., DAntonio F., Calf G., Palacios-Jaraquemada J., Meyer J., Monteagudo A. Early first-trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory? Ultrasound Obstet. Gynecol. 2019; 54(2): 156-63. https://dx.doi.org/10.1002/uog.20225.
  12. Jauniaux E., Ayres-de-Campos D.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Introduction. Int. J. Gynaecol. Obstet. 2018; 140(3): 261-4. https://dx.doi.org/10.1002/ijgo.12406.
  13. Jauniaux E., Ayres-de-Campos D., Langhoff-Roos J., Fox K.A., Collins S.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int. J. Gynaecol. Obstet. 2019; 146(1): 20-4. https://dx.doi.org/10.1002/ijgo.12761.
  14. Bossuyt P.M., Reitsma J.B., Bruns D.E., Gatsonis C.A., Glasziou P.P., Irwig L. et al.; STARD Group. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. BMJ. 2015; 351: h5527. https://dx.doi.org/10.1136/bmj.h5527.
  15. Cali G., Forlani F., Foti F., Minneci G., Manzoli L., Flacco M.E., Buca D., Liberati M., Scambia G., D'Antonio F. Diagnostic accuracy of first-trimester ultrasound in detecting abnormally invasive placenta in high-risk women with placenta previa. Ultrasound Obstet. Gynecol. 2018; 52(2): 258-64. https://dx.doi.org/10.1002/uog.19045.
  16. Comstock C.H., Bronsteen R.A. The antenatal diagnosis of placenta accreta. BJOG. 2014; 121(2): 171-81; discussion 181-2. https://dx.doi.org/10.1111/1471-0528.12557.
  17. Gonzalez N., Tulandi T. Cesarean scar pregnancy: A systematic review. J. Minim. Invasive Gynecol. 2017; 24(5): 731-8. https://dx.doi.org/10.1016/j.jmig.2017.02.020.
  18. Timor-Tritsch I.E., Monteagudo A., Cali G., El Refaey H., Kaelin Agten A., Arslan A.A. Easy sonographic differential diagnosis between intrauterine pregnancy and cesarean delivery scar pregnancy in the early first trimester. Am. J. Obstet. Gynecol. 2016; 215(2): 225.e1-7. https://dx.doi.org/10.1016/j.ajog.2016.02.028.
  19. Cali G., Timor-Trisch I.E., Palacios-Jaraquemada J., Monteaugudo A., Forlani F., Minneci G. et al. Changes in ultrasonography indicators of abnormally invasive placenta during pregnancy. Int. J. Gynaecol. Obstet. 2018; 140(3): 319-25. https://dx.doi.org/10.1002/ijgo.12413.
  20. Цхай В.Б., Яметов П.К., Вергунов Н.А. Беременность в рубце на матке после кесарева сечения. Современное состояние проблемы. Диагностика. Клиника. Врачебная тактика. Акушерство и гинекология. 2017; 3: 5-10. [Tskhay V.B., Yametov P.K., Vergunov N.A. Cesarean scar pregnancy. Current state of the problem. Diagnostics. Clinical symptoms. Medical tactics. Akusherstvo i ginekologiya/ Obstetrics and gynecology. 2017; 3: 5-10 (in Russian)]. https://dx.doi.org/10.18565/aig.2017.3.5-10.
  21. Makukhina T.B., Makukhina V.V. Ectopic low-lying implantation pregnancy: analysis of outcomes depending on gestation age. Rus. Open Med. J. 2019; 8: e0208. https://dx.doi.org/10.15275/rusomj.2019.0208.
  22. Пенжоян Г.А., Макухина Т.Б., Мингалева Н.В., Солнцева А.В., Амирханян А.М. Менеджмент пациенток с врастанием плаценты на разных сроках гестации. Акушерство и гинекология: новости мнения, обучение. 2019; 7(1): 79-84. https://dx.doi.org/10.24411/2303-9698-2019-11011.
  23. Демидов В.Н., Гус А.И., Ярыгина Т.А. О возможности высокоточной диагностики врастания плаценты в рубец на матке после кесарева сечения при ультразвуковом исследовании. Пренатальная диагностика. 2020; 19(4): 336-42. https://dx.doi.org/10.21516/2413-1458-2020-19-4-336-342.
  24. Гаязов Д.Р., Терегулова Л.Е., Терегулов А.Ю., Юсупова А.Ф. Лучевая диагностика и органосохраняющие операции при приращении плаценты. Практическая медицина. 2017; 7: 22-5.
  25. Буянова С.Н., Щукина Н.А., Чечнева М.А., Пучкова Н.В., Земскова Н.Ю., Торобаева М.Т. Беременность в рубце после кесарева сечения: возможности хирургической коррекции. Российский вестник акушера-гинеколога. 2020; 20(6): 65-70. https://dx.doi.org/10.17116/rosakush20202006165.
  26. Сонова М.М., Гашенко В.О., Ласкевич А.В., Торубаров С.Ф. Эктопическая беременность в рубце на матке после кесарева сечения. Проблемы репродукции. 2018; 24(1): 42-7. [Sonova M.M., Gashenko V.O., Laskevich A.V., Torubarov S.F. Ectopic pregnancy in the uterine scar after caesarean section. Problemy reprodukcii/Problems of Reproduction. 2018; 24(1): 42-7. (in Russian)]. https://dx.doi.org/10.17116/repro201824142-47.
  27. Николаидес К. Ультразвуковое исследование в 11-13+6 недель беременности. Пер. с англ. Михайлова А.В., Некрасовой Е.С. СПб.: ИД «Петрополис»; 2007. 144с
  28. Panaiotova J., Tokunaka M., Krajewska K., Zosmer N., Nicolaides K.H. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet. Gynecol. 2019; 53(1):101-6. https://dx.doi.org/10.1002/uog.20104.
  29. D'Antonio F., Cali G., Palacios-Jaraquemada J., Khalil A., Timor-Tritsch I.E. Cesarean scar pregnancy is associated with abnormal implantation but not macroscopic myometrial invasion in early first trimester of pregnancy. Ultrasound Obstet. Gynecol. 2022; 59(4): 550-1. https://dx.doi.org/10.1002/uog.24790.
  30. Doulaveris G., Ryken K., Papathomas D., Trejo F.E., Meislin R., Rotenberg O., Dar P. OC30.04: Performance of transvaginal ultrasound between 11-14 weeks in women with prior Caesarean delivery for early prediction of placenta accreta spectrum. Ultrasound Obstet. Gynecol. 2019; 54(Suppl. 1): 79-80.

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