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Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum.

Publication ,  Journal Article
Gatta, LA; Ellestad, SC; Boyd, BK; Collins, S; Einerson, BD; Stephenson, ML; Hammad, I; Varvoutis, MS; Honart, AW; Federspiel, JJ; Craig, AM ...
Published in: Am J Obstet Gynecol MFM
August 2023

BACKGROUND: To standardize research terminology and to reduce unanticipated placenta accreta spectrum, the European Working Group for Abnormally Invasive Placenta developed a consensus checklist for reporting suspected placenta accreta spectrum observed during an antenatal ultrasound. The diagnostic accuracy of the European Working Group for Abnormally Invasive Placenta checklist has not been assessed. OBJECTIVE: This study aimed to test the performance of the European Working Group for Abnormally Invasive Placenta sonographic checklist in predicting histologic placenta accreta spectrum. STUDY DESIGN: This was a multisite, blinded, retrospective review of transabdominal ultrasound studies performed between 26 to 32 weeks' gestation for subjects with histologic placenta accreta spectrum between 2016 and 2020. We matched a control cohort of subjects without histologic placenta accreta spectrum in a 1:1 ratio. To reduce reader bias, we matched the control cohort for known risk factors including previa, number of previous cesarean deliveries, previous dilation and curettage, in vitro fertilization, and clinical factors affecting image quality including multiple gestation, body mass index, and gestational age at the ultrasound. Nine sonologists from 5 referral centers, blinded to the histologic outcomes, interpreted the randomized ultrasound studies using the European Working Group for Abnormally Invasive Placenta checklist. The primary outcome was the sensitivity and specificity of the checklist to predict placenta accreta spectrum. Two separate sensitivity analyses were performed. First, we excluded subjects with mild disease (ie, only assessed subjects with histologic increta and percreta). Second, we excluded interpretations from the 2 most junior sonologists. RESULTS: A total of 78 subjects were included (39 placenta accreta spectrum, 39 matched control). Clinical risk factors and image quality markers were statistically similar between the cohorts. The checklist sensitivity (95% confidence interval) was 76.6% (63.4-90.6) and the specificity (95% confidence interval) was 92.0% (63.4-99.9) with a positive and negative likelihood ratio of 9.6 and 0.3, respectively. When we excluded subjects with mild placenta accreta spectrum disease, the sensitivity (95% confidence interval) increased to 84.7% (73.6-96.4) and the specificity was unchanged at 92.0% (83.2-99.9). Sensitivity and specificity were unchanged when the interpretations from the 2 most junior sonologists were excluded. CONCLUSION: The 2016 European Working Group for Abnormally Invasive Placenta checklist for interpreting placenta accreta spectrum has a reasonable performance in detecting histologic placenta accreta spectrum and excluding cases without placenta accreta spectum.

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Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

August 2023

Volume

5

Issue

8

Start / End Page

101017

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Pregnancy
  • Placenta Previa
  • Placenta Accreta
  • Placenta
  • Humans
  • Female
  • Checklist
  • 3215 Reproductive medicine
 

Citation

APA
Chicago
ICMJE
MLA
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Gatta, L. A., Ellestad, S. C., Boyd, B. K., Collins, S., Einerson, B. D., Stephenson, M. L., … Gilner, J. B. (2023). Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum. Am J Obstet Gynecol MFM, 5(8), 101017. https://doi.org/10.1016/j.ajogmf.2023.101017
Gatta, Luke A., Sarah C. Ellestad, Brita K. Boyd, Sally Collins, Brett D. Einerson, Megan L. Stephenson, Ibrahim Hammad, et al. “Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum.Am J Obstet Gynecol MFM 5, no. 8 (August 2023): 101017. https://doi.org/10.1016/j.ajogmf.2023.101017.
Gatta LA, Ellestad SC, Boyd BK, Collins S, Einerson BD, Stephenson ML, et al. Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum. Am J Obstet Gynecol MFM. 2023 Aug;5(8):101017.
Gatta, Luke A., et al. “Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum.Am J Obstet Gynecol MFM, vol. 5, no. 8, Aug. 2023, p. 101017. Pubmed, doi:10.1016/j.ajogmf.2023.101017.
Gatta LA, Ellestad SC, Boyd BK, Collins S, Einerson BD, Stephenson ML, Hammad I, Varvoutis MS, Honart AW, Federspiel JJ, Craig AM, Swartz A, Salinaro JR, Unnithan S, Weber J, Erkanli A, Gilner JB. Validation of a sonographic checklist for the detection of histologic placenta accreta spectrum. Am J Obstet Gynecol MFM. 2023 Aug;5(8):101017.
Journal cover image

Published In

Am J Obstet Gynecol MFM

DOI

EISSN

2589-9333

Publication Date

August 2023

Volume

5

Issue

8

Start / End Page

101017

Location

United States

Related Subject Headings

  • Ultrasonography, Prenatal
  • Pregnancy
  • Placenta Previa
  • Placenta Accreta
  • Placenta
  • Humans
  • Female
  • Checklist
  • 3215 Reproductive medicine