A Quantitative Structured Review of the Diagnostic Accuracy of First-Trimester Ultrasound for the Detection of Placenta Accreta Spectrum (PAS) among Women with High-Risk Pregnancy.

Abstract

Abstract Aim: This review will assess the of first-trimester ultrasound accuracy in detecting placenta accreta syndrome (PAS). There are two objectives: to calculate the sensitivity and specificity of first-trimester sonography and to determine the accuracy of first- trimester ultrasound signs for predicting PAS. Background: Placenta acreta spectrum (PAS) concerns the abnormal placental attachment to the uterine wall, is directly correlated with maternal morbidity and mortality, and may result in hysterectomy or preterm labour. Research suggests that PAS can be identified early in the first trimester which may improve maternal and foetal outcomes, negate the need for surgery, and allow for more effective delivery management. Data search: This study conducted an online search for studies concerning diagnostic imaging (published from 2018 onwards) in relevant medical databases such as MEDLINE, ProQuest, Scopus, the Web of Science, through the GCU library’s subject-specific databases. Methods: This study adopted a quantitative structured literature review (SLR) regarding the diagnostic efficacy of ultrasound for detecting high-risk cases of PAS in the first trimester of pregnancy. The QUADAS-2 assessment tool evaluated the selected articles for internal (bias) and external validity (applicability). Results: Three studies (two prospective and one retrospective) were selected via a PRISMA flowchart. The initial results were positive: each study individually indicated that first-trimester sonography had high levels of sensitivity and specificity and was effective at diagnosing PAS; however, due to the variability of the sonographic signs, it was challenging to synthesise these results. Conclusion: The findings from this review emphasised the challenges inherent in evaluating the first-trimester ultrasound diagnostic accuracy for PAS, which restricted this review's ability to answer the research question. While included studies supported the potential effectiveness of early ultrasound in PAS diagnosis, the inconsistent data demand a cautious interpretation. The considerable variability between studies highlighted a critical need for more rigorous future studies in this context that aim to establish standardised sonographic signs and diagnostic criteria to facilitate a more reliable assessment of ultrasound’s diagnostic performance.