Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta‐analysis

• Published in: Ultrasound in obstetrics & gynecology 2018-09, Vol.52 (3), p.304-309
• Main Authors: Buca, D., Liberati, M., Calì, G., Forlani, F., Caisutti, C., Flacco, M. E., Manzoli, L., Familiari, A., Scambia, G., D'Antonio, F.
• Format: Article
• Language: English
• Subjects: abnormally invasive placenta; Blood Loss, Surgical - statistics & numerical data; Data processing; Diagnosis; Erythrocytes; Evidence-based medicine; Female; Gestational age; Health risks; Hemorrhage; Humans; Intensive care; Magnetic Resonance Imaging - standards; Medical diagnosis; Meta-analysis; Morbidity; outcome; Placenta; placenta accreta; Placenta Accreta - diagnostic imaging; Placenta Accreta - surgery; placenta increta; placenta percreta; Platelets; Postpartum Hemorrhage - prevention & control; Pregnancy; Prenatal development; Prenatal diagnosis; Prospective Studies; Retrospective Studies; Risk Factors; Surgery; Systematic review; Treatment Outcome; Ultrasonography, Prenatal - standards; Urinary tract
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1002/uog.19070

ABSTRACT Objective To ascertain the impact of prenatal diagnosis on surgical outcome of women affected by abnormally invasive placenta (AIP). Methods MEDLINE, EMBASE, CINAHL and Cochrane databases were searched. Observed outcomes included: gestational age at birth (weeks), amount of blood loss (L), units of red blood cells (RBC), platelets (PLT) and fresh frozen plasma (FFP) transfused, length of stay in hospital and the intensive care unit (ICU) (days), urinary tract injury and infection. Only studies reporting the occurrence of any of the explored outcomes in women with a prenatal compared with an intrapartum diagnosis of AIP were considered eligible for inclusion. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Results Thirteen studies were included. Women with a prenatal diagnosis of AIP had less blood loss during surgery (mean difference (MD), −0.87; 95% CI, −1.5 to −0.23), had fewer units of RBC (MD, −1.45; 95% CI, −2.9 to −0.04) and FFP (MD, −1.73; 95% CI, −3.3 to −0.2) transfused, and delivered earlier (MD, 1.33 weeks; 95% CI, −2.23 to −0.43) compared with those with an intrapartum diagnosis. The risk of admission to an ICU and length of in‐hospital and in‐ICU stay were not different between the groups. Prenatal diagnosis of AIP was associated with a higher risk of urinary‐tract injury (odds ratio, 2.5; 95% CI, 1.3–4.6), mainly due to the higher prevalence of placenta percreta in the group with AIP diagnosed prenatally. Conclusion Prenatal diagnosis of AIP is associated with reduced hemorrhagic morbidity compared with cases in which such anomalies are detected at delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. RESUMEN Influencia del diagnóstico prenatal de placenta invasiva en el desenlace materno: revisión sistemática y metaanálisis Objetivo Determinar el impacto del diagnóstico prenatal en el desenlace quirúrgico de las mujeres afectadas por placenta invasiva (PI). Métodos Se buscó en las bases de datos MEDLINE, EMBASE, CINAHL y Cochrane. Los resultados observados incluyeron: edad gestacional al nacer (semanas), volumen de pérdida de sangre (L), unidades de glóbulos rojos (GR), plaquetas (PLT) y plasma fresco congelado (PFC) transfundido, tiempo de hospitalización y tiempo en la unidad de cuidados intensivos (UCI) (días), y lesión e infección del tracto urinario. Sólo se consideraron aptos para esta revisión los estudios que mencionaron la aparición de cualquiera de los resultados estudiados en mujere