Relationship Between The Cesarean Scar Pregnancy And The Placenta Accreta And The Diagnostic Value Of Different Ultrasonic Signs For Placenta Accreta

Part Ⅰ:Relationship between the cesarean scar pregnancy diagnosed by ultrasound examination and the placenta accretaObjective:The purpose of this study was to explore the relationship between the cesarean scar pregnancy diagnosed by ultrasound examination and the placenta accreta,to provide more the evidence-based medicine information for natural history of cesarean scar pregnancy,and by dividing CSPs into two groups to compare their pregnancy outcomes.Materials and Methods:We retrospectively analyzed the data of the 19 CSP patients who were diagnosed by ultrasound examination and desired to continue the pregnancy from January 2014 to February 2017 in Qilu Hospital.We obtained ultrasonic images,ultrasonic records,clinical data and pathological records.Besides,the patients were grouped(low-risk group and high-risk group)based on their early pregnancy ultrasound images diagnosed with the CSP,compared the clinical outcomes of two groups,to explore the relationship between cesarean scar pregnancy and placenta accreta.Results:19 cases of CSP diagnosed by ultrasound examination were included in the study,16(16/19)cases in the subsequent pregnancy ultrasonic examination diagnosed with placenta accreta.The sensitivity of placenta accreta diagnosed by ultrasound examination was 88.9%,and the positive predictive value was 100%.There were 18(18/19)cases diagnosed with placental accreta by "gold standard"examination,of which 4(4/18)cases were placental percreta.The patients with placenta percreta had significant ultrasonic sighs in the first trimester(12 weeks,12 weeks,9 weeks + 6 days,10 weeks).The CSP patients were divided into low risk group(n = 10)and high risk group(n = 9),then compare the clinical outcomes of the two groups.Live births were more in low risk group(n=9)than in high risk group(n=4),P=0.057.4(4/9)cases with placenta percreta were all in high risk group,P=0.033.Blood loss was higher in high group(median 2000ml,400-12000ml)than in low group(median 1100ml,200-5000ml),P=0.269.The two groups respectively had a patient with hysterectomy,P=1.000.Conclusion:Cesarean scar pregnancy was a precursor of placenta accreta.Patients with placenta percreta could appear typical ultrasonic manifestations of placenta accreta in first trimester.The classification of the CSP patients could be used to predict their clinical outcome.The clinical outcome in patient in the low-risk group was better than in the high-risk group.Part Ⅱ:The diagnostic value of prenatal different ultrasonic signs for placenta accreta:a meta analysisObjective:To explore the diagnostic value of prenatal different ultrasonic signs for placenta accreta by a meta analysis.Materials and Methods:Studies were searched in Pebmed,Cochrane library,CNKI,Wan Fang and VIP databases(2006.1-2016.10).Only the English and Chinese literatures were included in our study.The eligible studies were based on the inclusion and exclusion criteria and evaluated the quality according to the QUADAS-2 evaluation system.We used the Review Manager 5.3 and Meta-Discl.4 software to draw the plots and do some calculations.We calculated the pooled sensitivity(SEN),specificity(SPE),negative(LR-)and positive likelihood ratio(LR+),the diagnostic odds ratio(DOR)and their 95%CIs for the different sighs.Summary receiver operating characteristic curves(SROC)and area under curves(AUC)were used for ultrasound sighs for more than 5 studies reference.Results:A total of 12 studies were included,Involving 1392 pregnancies at r isk for invasive placentation.In summary,the ultrasonic sighs were as follows:Loss or irregular of retroplacental clear space:SEN0.83(0.78-0.88),SPE0.86(0.83-0.88),AUC0.9042;Placenta lacunae in placenta:SEN0.71(0.67-0.76),SP E0.83(0.81-0.85),AUC0.8580;Bladder-border abnormalities:SEN0.46(0.38-0.54),SPE0.98(0.96-0.99),AUC0.9083;Hypervascularity of placenta and uterine-bl adder interface:SEN0.67(0.60-0.72),SPE0.95(0.93-0.96),AUC0.9470;Bridgin g vessels in placenta:SEN0.59(0.50-0.68),SPE0.91(0.88-0.94);Exophytic uteri ne masses:SEN0.23(0.17-0.32),SPE0.98(0.96-0.99);Myometrial thickness<lm m:SEN0.58(0.50-0.66),SPE0.92(0.89-0.94).Conclusions:All different ultrasonic sighs had the accuracy of prenatal diagnosis of placenta accreta in high risk woman.Placenta lacunae as an ultrasonic sign should be combined with the color doppler flow Imaging.Hypervascularity of placenta/uterine-bladder interface had the best diagnostic value in all ultrasonic sighs.