Clinical Study Of Serum Biomarkers And Ultrasound Markers Of Placenta Accreta Spectrum

Background:With the adjustment of the birth policy,the significant increasing rate of previous cesarean section,the incidence of placenta accreta spectrum(PAS)diseases has increased year by year.Since PAS may lead to a catastrophic obstetric outcome,accurate prenatal diagnosis should be made in advance to guarantee the safety of mother and child.At present,the main measure of prenatal screening of PAS is ultrasound in clinic.In addition,some maternal serum biomarkers can help prenatal diagnosis of PAS,of which cell-free fetal DNA test in maternal serum has begun to be investigated.Objective:The objective of this study is to assess the predictive capacity of serum cell-free fetal DNA(cffDNA)and ultrasound markers for PAS disorders among high-risk women.Methods:1.Maternal serum cffDNA study:This is a retrospective case-control study,we enrolled women with PAS compared to normal pregnant women.By using their cffDNA fraction of non-invasive prenatal testing during pregnancy,we compared the fraction of cffDNA between PAS and normal pregnant women.The cut-off value was obtained by ROC curve.2.Ultrasound markers study:This was a systematic review conducted following the Cochrane Diagnostic Test Accuracy Reviews Guidelines.A literature search was performed in two database:Pubmed,MEDLINE.Studies published between January 2012 and November 2022 and updated on December 20,2022.A total of 12 studies were selected.Quality Assessment of Diagnostic Accuracy Studies-2 was used to assess the quality of the studies.Forest plots for sensitivity and specificity with 95%CIs for ultrasound markers were constructed.Results:1.The groups did not differ in age,BMI,gravidity and parity,assisted reproduction,and history of uterine surgery.When controlling for the above factors,the mean value of cffDNA fragment in maternal serum of PAS patients was 0.1591,which was significantly higher than that of control group(P=0.014,<0.05).Therefore,the ROC curve was established and the area under the curve(AUC)was calculated as 0.605(95%CI:0.523-0.608,p=0.014),and the cut-off value of cffDNA fragment was calculated as 0.1655(sensitivity 42.4%,specificity 82.6%).2.A literature search ultimately identified a total of 12 studies including 2643 women with high risk factor for PAS.The overall quality of the studies evaluated was considered satisfactory according to QUADAS-2.The meta-analysis revealed a sensitivity of 0.89(95%CI,0.82-0.94)and a specificity of 0.97(95%CI,0.95-0.99)for ultrasound.The meta-analysis for ultrasound markers:the sensitivity and specificity of placental lacunae were 0.81(95%CI,0.62-0.91)and 0.89(95%CI,0.80-0.94)respectively.The sensitivity and specificity were 0.81(95%CI,0.68-0,90)and 0.94(95%CI,0.85-0.98)for the loss of clear zone.The sensitivity and specificity of hysterovesical interface abnormalities were 0.57(95%CI,0.35-0.77)and 0.99(95%CI,0.97-1.00).The sensitivity and specificity of increased subplacental blood flow were 0.81(95%CI,0.77-0.93)and 0.99(95%CI,0.73,1.00).Conclusion:According to our data,it can be concluded that cffDNA is of low diagnostic efficacy in assisting prenatal diagnosis of PAS.Ultrasound has high sensitivity and specificity for the prenatal diagnosis of PAS,and different ultrasonic markers have different sensitivity and specificity for their prenatal diagnosis.ALL above results revealed that we can further improve the universality of prenatal diagnosis of placenta accreta spectrum disorders by combining ultrasound and serum markers.