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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Modified Delphi study of ultrasound signs associated with placenta accreta spectrum
Ultrasound in Obstetrics and Gynecology, Volume 61, No. 4, Year 2023
Notification
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Description
Objective: To determine, by expert consensus through a modified Delphi process, the role of standardized and new ultrasound signs in the prenatal evaluation of patients at high risk of placenta accreta spectrum (PAS). Methods: A systematic review of articles providing information on ultrasound imaging signs or markers associated with PAS was performed before the development of questionnaires for the first round of the Delphi process. Only peer-reviewed original research studies in the English language describing one or more new ultrasound sign(s) for the prenatal evaluation of PAS were included. A three-round consensus-building Delphi method was then conducted under the guidance of a steering group, which included nine experts who invited an international panel of experts in obstetric ultrasound imaging in the evaluation of patients at high risk for PAS. Consensus was defined as agreement of ≥ 70% between participants. Results: The systematic review identified 15 articles describing eight new ultrasound signs for the prenatal evaluation of PAS. A total of 35 external experts were approached, of whom 31 agreed and participated in the first round. Thirty external experts (97%) and seven experts from the steering group completed all three Delphi rounds. A consensus was reached that a prior history of at least one Cesarean delivery, myomectomy or PAS should be an indication for detailed PAS ultrasound assessment. The panelists also reached a consensus that seven of the 11 conventional signs of PAS should be included in the examination of high-risk patients and the routine mid-gestation scan report: (1) loss of the ‘clear zone’, (2) myometrial thinning, (3) bladder-wall interruption, (4) placental bulge, (5) uterovesical hypervascularity, (6) placental lacunae and (7) bridging vessels. A consensus was not reached for any of the eight new signs identified by the systematic review. With respect to other ultrasound features that are not specific to PAS but increase the probability of PAS at birth, the panelists reached a consensus for the finding of anterior placenta previa or placenta previa with cervical involvement. The experts were also asked to determine which PAS signs should be quantified and consensus was reached only for the quantification of placental lacunae using an existing score. For predicting surgical outcome in patients with a high probability of PAS at delivery, a consensus was obtained for loss of the clear zone, bladder-wall interruption, presence of placental lacunae and presence of placenta previa involving the cervix. Conclusions: We have confirmed the continued importance of seven established standardized ultrasound signs of PAS, highlighted the role of transvaginal ultrasound in evaluating the placental position and anatomy of the cervix, and identified new ultrasound signs that may become useful in the future prenatal evaluation and management of patients at high risk for PAS at birth. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Authors & Co-Authors
Jauniaux, Eric R.M.
United Kingdom, London
University College London
D'antonio, Francesco
Italy, Chieti
University of G. D'annunzio Chieti and Pescara
Bhide, Amarnath G.
United Kingdom, London
St George's Hospital
Prefumo, Federico
Italy, Genoa
Istituto Giannina Gaslini
Silver, Robert M.
United States, Salt Lake City
University of Utah School of Medicine
Hussein, Ahmed M.
Egypt, Cairo
Faculty of Medicine
Shainker, S. A.
United States, Boston
Beth Israel Deaconess Medical Center
Chantraine, F.
Belgium, Liege
Centre Hospitalier Universitaire de Liege
Alfirevic, Zarko
United Kingdom, Liverpool
University of Liverpool
Abuhamad, Alfred Z.
Unknown Affiliation
Aryananda, Rozi A.
Unknown Affiliation
Calì, Giuseppe
Unknown Affiliation
Coutinho, Conrado M.
Unknown Affiliation
Dall'Asta, Andrea
Unknown Affiliation
de Carvalho Afonso, Maria
Unknown Affiliation
Deniega, Veronica M.
Unknown Affiliation
Einerson, Brett D.
Unknown Affiliation
Fox, Karin Anneliese
Unknown Affiliation
Halaj, Matus
Unknown Affiliation
Hanulikova, Petra
Unknown Affiliation
Kennedy, Anne
Unknown Affiliation
Kingdom, John C.P.
Unknown Affiliation
Lees, Christoph C.
Unknown Affiliation
Leung, Ky
Unknown Affiliation
Leung, Wing Cheong
Unknown Affiliation
Liu, Zengping
Unknown Affiliation
Henrich, Wolfgang
Unknown Affiliation
Maymon, Ron
Unknown Affiliation
Mhallem, Mina G.
Unknown Affiliation
Morel, Olivier
Unknown Affiliation
Rac, Martha
Unknown Affiliation
Rijken, Marcus J.
Unknown Affiliation
Shih, Jin Chung
Unknown Affiliation
Stefanovic, Vedran
Unknown Affiliation
Sundberg, Karin M.
Unknown Affiliation
Woodward, Paula
Unknown Affiliation
Yang, Huixia
Unknown Affiliation
Zosmer, Nurit
Unknown Affiliation
Zuckerwise, Lisa C.
Unknown Affiliation
Statistics
Citations: 39
Authors: 39
Affiliations: 9
Identifiers
Doi:
10.1002/uog.26155
ISSN:
09607692
e-ISSN:
14690705
Research Areas
Health System And Policy
Maternal And Child Health
Study Approach
Systematic review