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Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Garofalo A, Viora E, Vergani P, Ornaghi S, Betti M, Vaglio Tessitore I, Cavaliere AF, Buongiorno S, Vidiri A, Fabbri E, Ferrazzi E, Maggi V, Cetin I, Frusca T, Ghi T, Kaihura C, Di Pasquo E, Stampalija T, Belcaro C, Quadrifoglio M, Veneziano M, Mecacci F, Simeone S, Locatelli A, Consonni S, Chianchiano N, Labate F, Cromi A, Bertucci E, Facchinetti F, Fichera A, Granata D, D'Antonio F, Foti F, Avagliano L, Bulfamante G, Calì G. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol 2022; 60:381-389. [PMID: 35247287 PMCID: PMC9544821 DOI: 10.1002/uog.24889] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To evaluate the performance of third-trimester ultrasound for the diagnosis of clinically significant placenta accreta spectrum disorder (PAS) in women with low-lying placenta or placenta previa. METHODS This was a prospective multicenter study of pregnant women aged ≥ 18 years who were diagnosed with low-lying placenta (< 20 mm from the internal cervical os) or placenta previa (covering the internal cervical os) on ultrasound at ≥ 26 + 0 weeks' gestation, between October 2014 and January 2019. Ultrasound suspicion of PAS was raised in the presence of at least one of these signs on grayscale ultrasound: (1) obliteration of the hypoechogenic space between the uterus and the placenta; (2) interruption of the hyperechogenic interface between the uterine serosa and the bladder wall; (3) abnormal placental lacunae. Histopathological examinations were performed according to a predefined protocol, with pathologists blinded to the ultrasound findings. To assess the ability of ultrasound to detect clinically significant PAS, a composite outcome comprising the need for active management at delivery and histopathological confirmation of PAS was considered the reference standard. PAS was considered to be clinically significant if, in addition to histological confirmation, at least one of these procedures was carried out after delivery: use of hemostatic intrauterine balloon, compressive uterine suture, peripartum hysterectomy, uterine/hypogastric artery ligation or uterine artery embolization. The diagnostic performance of each ultrasound sign for clinically significant PAS was evaluated in all women and in the subgroup who had at least one previous Cesarean section and anterior placenta. Post-test probability was assessed using Fagan nomograms. RESULTS A total of 568 women underwent transabdominal and transvaginal ultrasound examinations during the study period. Of these, 95 delivered in local hospitals, and placental pathology according to the study protocol was therefore not available. Among the 473 women for whom placental pathology was available, clinically significant PAS was diagnosed in 99 (21%), comprising 36 cases of placenta accreta, 19 of placenta increta and 44 of placenta percreta. The median gestational age at the time of ultrasound assessment was 31.4 (interquartile range, 28.6-34.4) weeks. A normal hypoechogenic space between the uterus and the placenta reduced the post-test probability of clinically significant PAS from 21% to 5% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 9% in the subgroup with previous Cesarean section and anterior placenta. The absence of placental lacunae reduced the post-test probability of clinically significant PAS from 21% to 9% in women with low-lying placenta or placenta previa in the third trimester of pregnancy and from 62% to 36% in the subgroup with previous Cesarean section and anterior placenta. When abnormal placental lacunae were seen on ultrasound, the post-test probability of clinically significant PAS increased from 21% to 59% in the whole cohort and from 62% to 78% in the subgroup with previous Cesarean section and anterior placenta. An interrupted hyperechogenic interface between the uterine serosa and bladder wall increased the post-test probability for clinically significant PAS from 21% to 85% in women with low-lying placenta or placenta previa and from 62% to 88% in the subgroup with previous Cesarean section and anterior placenta. When all three sonographic markers were present, the post-test probability for clinically significant PAS increased from 21% to 89% in the whole cohort and from 62% to 92% in the subgroup with previous Cesarean section and anterior placenta. CONCLUSIONS Grayscale ultrasound has good diagnostic performance to identify pregnancies at low risk of PAS in a high-risk population of women with low-lying placenta or placenta previa. Ultrasound may be safely used to guide management decisions and concentrate resources on patients with higher risk of clinically significant PAS. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N. Fratelli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - F. Prefumo
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Maggi
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - C. Cavalli
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - A. Sciarrone
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - A. Garofalo
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - E. Viora
- Obstetrics–Gynecological Ultrasound and Prenatal Diagnosis Unit, Department of Obstetrics and GynecologyCittà della Salute e della ScienzaTurinItaly
| | - P. Vergani
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - S. Ornaghi
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - M. Betti
- Obstetrics and Gynaecology Unit, A. Manzoni Hospital, ASST LeccoLeccoItaly
| | - I. Vaglio Tessitore
- University of Milan‐Bicocca, School of Medicine and Surgery, Department of Obstetrics and GynecologyFondazione MBBM Onlus, San Gerardo HospitalMonzaItaly
| | - A. F. Cavaliere
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - S. Buongiorno
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - A. Vidiri
- Dipartimento Scienze della Salute della Donna e del Bambino e di Sanità PubblicaFondazione Policlinico Universitario ‘A. Gemelli’ IRCCS‐Università Cattolica del Sacro CuoreRomeItaly
| | - E. Fabbri
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - E. Ferrazzi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
- Department of Clinical and Community SciencesUniversity of MilanMilanItaly
| | - V. Maggi
- Fondazione IRCCS Ca Granda Ospedale Maggiore PoliclinicoMilano, Unit of ObstetricsMilanItaly
| | - I. Cetin
- Obstetrics and Gynecology UnitBuzzi Children's Hospital, University of MilanMilanItaly
| | - T. Frusca
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Ghi
- Department of Medicine and SurgeryUniversity of ParmaParmaItaly
| | - C. Kaihura
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - E. Di Pasquo
- Department of Medicine and Surgery, Obstetrics and Gynaecology UnitUniversity of ParmaParmaItaly
| | - T. Stampalija
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
- Department of Medical, Surgical and Health ScienceUniversity of TriesteTriesteItaly
| | - C. Belcaro
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Quadrifoglio
- Unit of Fetal Medicine and Prenatal DiagnosisInstitute for Maternal and Child Health, IRCCS Burlo GarofoloTriesteItaly
| | - M. Veneziano
- Obstetrics and Gynecology UnitBolzano HospitalBolzanoItaly
| | - F. Mecacci
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - S. Simeone
- Department of Woman and Child's HealthCareggi University HospitalFlorenceItaly
| | - A. Locatelli
- University of Milan‐Bicocca, School of Medicine and Surgery, Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - S. Consonni
- Obstetrics and Gynecology Unit, Carate Brianza Hospital, ASST BrianzaCarate BrianzaItaly
| | - N. Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla–Fatebenefratelli HospitalPalermoItaly
| | - F. Labate
- Department of Obstetrics and GynaecologyAzienda Ospedaliera Villa Sofia CervelloPalermoItaly
| | - A. Cromi
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | - E. Bertucci
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - F. Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Children and AdultsUniversity of Modena and Reggio Emilia School of MedicineModenaItaly
| | - A. Fichera
- Division of Obstetrics and Gynecology, ASST Spedali Civili, Department of Clinical and Experimental SciencesUniversity of BresciaBresciaItaly
| | - D. Granata
- Obstetrics and Gynecology UnitBolognini HospitalSeriateItaly
| | - F. D'Antonio
- Center for Fetal Care and High‐Risk Pregnancy, Department of Obstetrics and GynecologyUniversity of ChietiChietiItaly
| | - F. Foti
- Obstetrics and Gynecology Unit, Civico Hospital of PartinicoPalermoItaly
| | - L. Avagliano
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. P. Bulfamante
- Department of Health SciencesUniversità degli Studi di MilanoMilanItaly
| | - G. Calì
- Department of Obstetrics and GynaecologyArnas Civico HospitalPalermoItaly
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Morales-Roselló J, Loscalzo G, Buongiorno S, Cañada Martínez AJ. Information about fetal sex neither affects CPR nor improves CPR prediction of adverse perinatal outcome at end of pregnancy. Ultrasound Obstet Gynecol 2020; 56:293-295. [PMID: 32738106 DOI: 10.1002/uog.22130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 06/11/2023]
Affiliation(s)
- J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Departmento de Pediatría, Obstetricia y Ginecología, Universidad de Valencia, Valencia, Spain
| | - G Loscalzo
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Buongiorno
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - A J Cañada Martínez
- Unidad de Bioestadística, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Rosati P, Buongiorno S, Salvi S, Guariglia L, Lanzone A, Morales-Roselló J. Reproducibility of the fetal cerebral vessels assessment in full and late term pregnancies. J Matern Fetal Neonatal Med 2018; 33:2159-2165. [PMID: 30474451 DOI: 10.1080/14767058.2018.1542681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Data concerning feasibility of the fetal cerebral Doppler examination in full term and late term pregnancy is lacking. Our purpose was to perform an evaluation of these arteries with power Doppler ultrasound, calculating the percentage of identification and measurement and the intraobserver reproducibility.Methods: This was a cross sectional study evaluating a population of 578 normally grown fetuses divided according to the week of examination. The first group included fetuses examined at week 40 (N = 323) and the second fetuses examined at week 41 (N = 255). The three major branches of the internal carotid artery (anterior, middle and posterior cerebral arteries, ACA, middle cerebral artery (MCA), posterior cerebral arteries (PCA)) and their anastomosis (A1, A2, P1, P2) were examined with power Doppler ultrasonography by three independent ultrasonographers. The proportion of vessel identified and measured was calculated and the reproducibility among the three operators was investigated.Results: The major arteries at the circle of Willis were fully identified/measured in 65/56 and 62/48% of fetuses at 40 and 41 weeks. The MCA obtained the higher percentage of identification and measurement at both periods (> 80 and >70%). The entire set of anastomosis were less frequently identified/measured at both periods (50/< 50% of cases), especially in the A2 segment. The best agreement was obtained in the MCA and the worst in the PCA-P1 segment.Conclusions: At 40 and 41 weeks, the fetal cerebral vessels, especially the MCA, are suitable for power Doppler evaluation, providing an interesting tool to evaluate fetal hemodynamics in full and late term pregnancy.
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Affiliation(s)
- P Rosati
- Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - S Buongiorno
- Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - S Salvi
- Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - L Guariglia
- Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - A Lanzone
- Department of Woman and Child Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - J Morales-Roselló
- Servicio de Obstetricia, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Rosati P, Ciliberti P, Buongiorno S, Alessio A, Mappa I, Guariglia L, Capelli G, Scambia G. [Ultrasonographic and clinical methods in the management of prolonged pregnancy]. Minerva Ginecol 2014; 66:193-199. [PMID: 24848077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this study was to evaluate the role of Bishop score, sonographic measurements of uterine cervical length and maternal characteristics, as predictors of spontaneous onset of labor within 24 hours, as well as response to induction in prolonged pregnancies. METHODS Pregnancies with gestational age over 280 days were followed as outpatient. Patients were included in the study if spontaneous delivery occurred between 286 and 295 days of gestation, or in pregnancies with gestational age of 291-293 days who required labor induction. Data about Bishop score, ultrasonographic cervical characteristics (length, funneling, volume) and maternal features (parity, body mass index and age) registered at the last control immediately before the delivery were retrieved from clinical charts. RESULTS Data from 195 patients were available. Bishop score and, in particular, ultrasonographic cervical length can predict the spontaneous onset of labor with a positive predictive value (PPV) of 22% and 44%, respectively in 24 hours. On the other hands, in patients requiring labor induction, parity and ultrasonographic cervical length remained the only predictive parameters with a PPV of 39% and 42%, respectively. In term of predictive performance, the value of 30 mm was identified as the best cut-off value for the ultrasonographic cervical length (specificity 59% and sensitivity 69%). CONCLUSION In prolonged pregnancies, Bishop score and ultrasonographic cervical length were shown to be relevant in the prediction of spontaneous onset of labor, while in patients who required labor induction, ultrasonographic cervical length represented the only clinic parameter predicting the onset of labor.
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Affiliation(s)
- P Rosati
- Dipartimento per la Tutela della Salute della Donna e della Vita Nascente Università Cattolica del Sacro Cuore, Roma, Italia -
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Triunfo S, Rosati P, Lai M, Guariglia L, Alessio A, Buongiorno S, Ciliberti P, Scambia G. W032 CORRELATION BETWEEN ‘PEAK SYSTOLIC VELOCITY IN MIDDLE CEREBRAL ARTERY AND INDIRECT COOMBS’ TEST IN PREGNANCIES COMPLICATED BY ALLOIMMUNIZATION: TEN-YEARS EXPERIENCE OF A TERTIAN LEVEL CENTER. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Triunfo S, Alessio A, Mappa I, Rosati P, Guariglia L, Ciliberti P, Buongiorno S, Scambia G. W335 MANAGEMENT OF POST TERM PREGNANCY: A COMPARISON BETWEEN TWO DIFFERENT MANAGEMENT APPROACHES. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)62058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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