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CC BY 4.0 · Rev Bras Ginecol Obstet 2022; 44(09): 838-844
DOI: 10.1055/s-0042-1751061
Original Article
Obstetrics

Placenta Accreta Spectrum Prenatal Diagnosis Performance: Are Ultrasound False-positive Results Acceptable in Limited-resources Settings?

Desempenho do diagnóstico pré-natal do espectro da placenta acreta: Os resultados falso-positivos do ultrassom são aceitáveis em ambientes com recursos limitados?
Albaro José Nieto-Calvache 
1   Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
,
Juan Pablo Benavides-Calvache 
1   Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
,
Alejandra Hidalgo 
2   Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
,
Natalia Padilla 
2   Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
,
Jaime López-Tenorio 
1   Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
,
Alejandro Victoria 
1   Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
,
Martin Rengifo 
3   Departamento de Radiología, Fundación Valle del Lili, Cali, Colombia
,
Mauricio Mejía 
3   Departamento de Radiología, Fundación Valle del Lili, Cali, Colombia
,
Lina María Vergara-Galliadi 
2   Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
,
Stiven Ernesto Sinisterra-Díaz 
2   Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
,
Juliana Maya 
4   Facultad de Ciencias de la Salud, Programa de Medicina, Universidad Icesi, Cali, Colombia
,
María Andrea Zambrano 
5   Facultad de Ciencias de la Salud, Programa de Ginecología y Obstetricia, Universidad Icesi, Cali, Colombia
,
Juan Manuel Burgos-Luna 
1   Clínica de Espectro de Acretismo Placentario, Fundación Valle del Lili, Cali, Colombia
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Abstract

Objective The immediate referral of patients with risk factors for placenta accreta spectrum (PAS) to specialized centers is recommended, thus favoring an early diagnosis and an interdisciplinary management. However, diagnostic errors are frequent, even in referral centers (RCs). We sought to evaluate the performance of the prenatal diagnosis for PAS in a Latin American hospital.

Methods A retrospective descriptive study including patients referred due to the suspicion of PAS was conducted. Data from the prenatal imaging studies were compared with the final diagnoses (intraoperative and/or histological).

Results A total of 162 patients were included in the present study. The median gestational age at the time of the first PAS suspicious ultrasound was 29 weeks, but patients arrived at the PAS RC at 34 weeks. The frequency of false-positive results at referring hospitals was 68.5%. Sixty-nine patients underwent surgery based on the suspicion of PAS at 35 weeks, and there was a 28.9% false-positive rate at the RC. In 93 patients, the diagnosis of PAS was ruled out at the RC, with a 2.1% false-negative frequency.

Conclusion The prenatal diagnosis of PAS is better at the RC. However, even in these centers, false-positive results are common; therefore, the intraoperative confirmation of the diagnosis of PAS is essential.

Resumo

Objetivo Recomenda-se o encaminhamento imediato de pacientes com fatores de risco para espectro placentário acreta (PAS, na sigla em inglês) para centros especializados, favorecendo assim o diagnóstico precoce e o manejo interdisciplinar. No entanto, erros diagnósticos são frequentes, mesmo em centros de referência (CRs). Buscou-se avaliar o desempenho do diagnóstico pré-natal para PAS em um hospital latino-americano.

Métodos Um estudo descritivo retrospectivo incluindo pacientes encaminhados por suspeita de SAP foi realizado. Os dados dos exames de imagem do pré-natal foram comparados com os diagnósticos finais (intraoperatórios e/ou histológicos).

Resultados Foram incluídos 162 pacientes no presente estudo. A idade gestacional mediana no momento da primeira ultrassonografia suspeita de PAS foi de 29 semanas, mas as pacientes chegaram ao CR de PAS com 34 semanas. A frequência de resultados falso-positivos nos hospitais de referência foi de 68,5%. Sessenta e nove pacientes foram operadas com base na suspeita de PAS com 35 semanas e houve 28,9% de falso-positivos no CR. Em 93 pacientes, o diagnóstico de PAS foi descartado no CR, com frequência de falso-negativos de 2,1%.

Conclusão O diagnóstico pré-natal de PAS é melhor no CR. Entretanto, mesmo nestes centros, resultados falso-positivos são comuns; portanto, a confirmação intraoperatória do diagnóstico de SAP é essencial.

Keywords

placenta accreta - ultrasonography - false positive - prenatal ultrasonic diagnosis - operative surgical procedure

Palavras-chave

placenta acreta - ultrassonografia - falso positivo - diagnóstico ultrassônico pré-natal - procedimento cirúrgico operatório

Contributions

All authors contributed to the design of the study and were involved in the data collection, data analysis and/or interpretation. Also, all authors contributed to the writing/substantive editing and review of the manuscript and approved the final draft of the manuscript.




Publication History

Received: 06 January 2022

Accepted: 28 April 2022

Article published online:
06 September 2022

© 2022. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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