背景:本研究旨在评估妊娠早期超声检测胎盘植入谱(PAS)的诊断准确性,并将其与妊娠中期和晚期超声在有PAS风险的妊娠中的准确性进行比较。
方法:PubMed,Embase,和WebofScience,搜索数据库以确定从开始到3月10日发表的相关研究,2023年。纳入标准是所有研究,包括队列,病例控制,或横断面研究,评估了妊娠前14周(妊娠早期)或妊娠后14周(妊娠中期/妊娠中期)进行的妊娠早期超声诊断的准确性。主要结果是评估早期妊娠中超声检测PAS的诊断准确性,并将其与第二和第三孕期超声的准确性进行比较。次要结果是评估每种超声标记在妊娠三个月中的诊断准确性。参考标准为病理或手术检查证实的PAS。超声和不同超声征象检测PAS的潜力是通过计算灵敏度的摘要估计来评估的。特异性,诊断比值比(DOR)和阳性(LR+)和阴性(LR-)似然比。
结果:共有37项研究,包括5,764例妊娠有PAS风险,有1348例确诊的PAS,包括在我们的分析中。荟萃分析的敏感性为86%(95%CI:78%,92%)和63%的特异性(95%CI:55%,70%)在孕早期,而敏感性为88%(95%CI:84%,91%),特异性为92%(95%CI:85%,96%)在第二/第三三个月期间。关于妊娠早期检查的超声标志物,下子宫血管过度表现出最高的敏感性,为97%(95%CI:19%,100%),和子宫膀胱界面不规则表现出最高的特异性为99%(95%CI:96%,100%)。然而,在第二/第三三个月,透明区损失的灵敏度最高,为80%(95%CI:72%,86%),而子宫膀胱界面不规则表现出99%的最高特异性(95%CI:97%,100%)。
结论:妊娠早期超声诊断PAS的准确性与妊娠中期和妊娠晚期超声相似。对PAS高危患者进行常规的妊娠早期超声筛查可能会提高检出率,并允许早期转诊到三级护理中心进行妊娠管理。本文受版权保护。保留所有权利。
OBJECTIVE: To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second- and third-trimester ultrasound examination in pregnancies at risk for PAS.
METHODS: PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case-control or cross-sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios.
RESULTS: A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta-analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78-92%) and specificity of 63% (95% CI, 55-70%) during the first trimester, and a sensitivity of 88% (95% CI, 84-91%) and specificity of 92% (95% CI, 85-96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19-100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96-100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72-86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97-100%)).
CONCLUSIONS: First-trimester ultrasound examination has similar accuracy to second- and third-trimester ultrasound examinations for the diagnosis of PAS. Routine first-trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.