Bhide, A;
Hussein, AM;
Elbarmelgy, RM;
Elbarmelgy, RA;
Thabet, MM;
Jauniaux, E;
(2023)
Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance.
Ultrasound in Obstetrics & Gynecology
, 62
(1)
pp. 137-142.
10.1002/uog.26196.
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Abstract
OBJECTIVES: The aims of this study were to evaluate the prenatal ultrasound features associated with operative complications and to assess the interobserver agreement in a cohort with detailed intraoperative and histopathologic data. METHODS: We conducted a retrospective, multicentre cohort study of 102 patients at high-risk of placenta accreta spectrum (PAS) between January 2019 and May 2022. De-identified ultrasound images were reviewed retrospectively and independently by two experienced operators blinded to clinical details, intra-operative features, outcome, and the histopathologic findings. The diagnosis of PAS was confirmed by the failure of detachment of one or more placental cotyledon from the uterine wall at delivery and the absence of decidua with distortion of the utero-placental interface by fibrinoid deposition on histologic examination of the accreta areas obtained by guided-sampling of partial myometrial resection or hysterectomy specimens. Antenatal categorisation was low or high probability of the likelihood of PAS at birth. Interobserver agreement was assessed using kappa statistic. Primary outcome was major operative morbidity (blood loss of ≥2000 ml, unintentional injury to the viscera, admission to intensive care unit or death). RESULTS: There were 66 cases with, and 36 cases without evidence PAS at birth. When blinded to other clinical details, the examiners agreed on the low or high probability of PAS in 87/102 cases (73.5%) on ultrasound features. The kappa statistic is 0.47 (95% CI: 0.28 - 0.66) showing moderate agreement. Morbidity was twice as common with a diagnosis of PAS. Concordant assessment of high probability of PAS was associated with the highest morbidity (66.6%) and a high (97.6%) chance of histopathological confirmation. CONCLUSIONS: The probability of histopathological confirmation is exceedingly high with concordant prenatal assessment suggestive of PAS. The interoperator agreement for preoperative assessment for histopathological confirmation of PAS is only moderate. Morbidity is linked to both histopathological diagnosis and antenatal assessment concordant of PAS. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1002/uog.26196 |
| Publisher version: | https://doi.org/10.1002/uog.26196 |
| Language: | English |
| Additional information: | © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Placenta previa accrete, placenta increta, surgical outcome, transvaginal ultrasound, ultrasound imaging |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Reproductive Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10167106 |
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