Accuracy of ultrasound in prediction of abnormal placental adherence: a systematic review and meta-analysis

Background

The accuracy of ultrasound in detecting invasive placentation, such as placenta accreta spectrum (PAS), remains a topic of debate. Accurate prenatal diagnosis is crucial to improve maternal outcomes, especially in women with high-risk factors..

Objective

This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of ultrasonography in predicting invasive placentation among at-risk pregnant women.

Study Design

A comprehensive search of multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) was conducted to identify studies assessing the diagnostic accuracy of ultrasound in detecting PAS. A total of 24 studies, including 1,509 high-risk pregnancies, met the inclusion criteria. Data on sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were extracted and analyzed.

Results

The meta-analysis demonstrated that ultrasound has a high diagnostic performance, with a pooled sensitivity of 91.73% (95% CI: 88.3–94.7%) and specificity of 97.95% (95% CI: 97.4–98.6%). The DOR was 99.6 (95% CI: 49.9–200.1). Among ultrasound modalities, color Doppler showed the highest predictive accuracy with a sensitivity of 91.75% (95% CI: 86.3–95.6%) and specificity of 87.69% (95% CI: 85.7–91.5%).

Conclusion

Ultrasound, especially with the use of color Doppler, is highly effective in the prenatal diagnosis of PAS disorders in high-risk pregnancies. Early detection through ultrasound allows for better clinical management, reducing maternal morbidity by enabling planned interventions.