Accuracy of ultrasound for the detection of placenta accreta spectrum in a universal screening population

• Published in: International journal of gynecology and obstetrics 2023-06, Vol.161 (3), p.920-926
• Main Authors: Baumann, Hanna Elise, Pawlik, Laura Katharina Andrea, Hoesli, Irene, Schoetzau, Andreas, Schoenberger, Heidrun, Butenschoen, Annkathrin, Monod, Cécile, Manegold‐Brauer, Gwendolin
• Format: Article
• Language: English
• Subjects: Female; Humans; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Placenta - diagnostic imaging; placenta accreta; Placenta Accreta - diagnostic imaging; placenta increta; placenta percreta; Pregnancy; prenatal diagnosis; Prenatal Diagnosis - methods; Retrospective Studies; Ultrasonography; Ultrasonography, Prenatal - methods; ultrasound
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1002/ijgo.14595

Objectives The current study aimed to determine the sensitivity and specificity of ultrasound for the diagnosis of placenta accreta spectrum (PAS) in a universal screening population and assesses the added value of magnetic resonance imaging (MRI). Methods This retrospective analysis evaluated 5219 patients with singleton pregnancies who had a standardized ultrasound (US) examination in our unit and delivered at our institution between 2014 and 2019. Results A total of 181 (3.5%) of 5219 (100%) patients had a suspicion or diagnosis of PAS with US. The accuracy of US in detecting placenta increta/percreta showed a sensitivity of 100%, specificity of 99.9%, positive predictive value of 82.4%, and a negative predictive value of 100%. The diagnosis of all forms of PAS showed a sensitivity of 25.8%, specificity of 99.8%, positive predictive value of 80.8%, and a negative predictive value of 97.7%. MRI was concordant with US in 11 of 14 (78.5%) cases of severe forms of PAS and in three of 15 (20.0%) cases with placenta accreta. Conclusion A standardized US evaluation can be applied in a universal screening setting for the diagnosis of severe forms of PAS. MRI is a complementary examination in severe forms of PAS but seems of limited value to discriminate placenta accreta from placenta increta/percreta. Synopsis Ultrasound shows a high accuracy in detecting severe forms of placenta accreta spectrum such as placenta increta/percreta in a universal screening population.