Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;49(5):1313-1321.
doi: 10.1111/jog.15544. Epub 2023 Feb 16.

Placenta accreta spectrum disorders clinical practice guidelines: A systematic review

Giulia Capannolo  1 , Alice D'Amico  1 , Sara Alameddine  1 , Raffaella Di Girolamo  2 , Asma Khalil  3 , Giuseppe Calì  4 , Ilan T Trish  5 , Conrado M Coutinho  6 , Mauricio Herrera  7 , Marco Liberati  1 , Alessandro Lucidi  1 , Jose Palacios-Jaraquemada  8 , Danilo Buca  1 , Francesco D'Antonio  1
Affiliations

Placenta accreta spectrum disorders clinical practice guidelines: A systematic review

Giulia Capannolo et al. J Obstet Gynaecol Res. 2023 May.

Abstract

Objectives: To objectively assess the quality of the published clinical practice guidelines (CPGs) on the management of pregnancies complicated by placenta accreta spectrum (PAS)disorders.

Methods: MEDLINE, Embase, Scopus, and ISI Web of Science databases were searched. The following aspects related to the management of pregnancies with suspected PAS disorders were evaluated: risk factors for PAS, prenatal diagnosis, role of interventional radiology and ureteral stenting, and optimal surgical management. The assessment of risk of bias and quality assessment of the CPGs were performed using the (AGREE II) tool (Brouwers et al., 2010). To define a CPG as of good quality we adopted a cut-off score >60%.

Results: Nine CPGs were included. Specific risk factors for referral were assessed by 44.4% (4/9) of CPGs, mainly consisting in the presence of placenta previa and a prior cesarean delivery or uterine surgery. About 55.6% of CPGs (5/9) suggested ultrasound assessment of women with risk factors for PAS in the second and third trimester of pregnancy and 33.3% (3/9) recommended magnetic resonance imaging (MRI); 88.9% (8/9) of CPGs recommended cesarean delivery at 34-37 weeks of gestation. There was not generally consensus on the use of interventional radiology and ureteral stenting before surgery for PAS. Finally, hysterectomy was the recommend surgical approach by 77.8% (7/9) of the included CPGs.

Conclusion: Most of the published CPGs on PAS are generally of good quality. There was general agreement among the different CPGs on PAS as a regard as risk stratification, timing at diagnosis and delivery but not on the indication for MRI, use of interventional radiology and ureteral stenting.

Keywords: AGREE-II; guidelines; placenta accreta spectrum; ultrasound.

PubMed Disclaimer

References

REFERENCES

    1. Fonseca A, De Campos DA. Maternal morbidity and mortality due to placenta accreta spectrum disorders. Best Pract Res Clin Obstet Gynaecol. 2021;72:84-91. https://doi.org/10.1016/j.bpobgyn.2020.07.011
    1. D'Antonio F, Palacios-Jaraquemada JM, Timor-Trisch I, Cali G. Placenta accreta spectrum disorders: prenatal diagnosis still lacks clinical correlation. Acta Obstet Gynecol Scand. 2018;97(7):773-5. https://doi.org/10.1111/aogs.13374
    1. Iacovelli A, Liberati M, Khalil A, Timor-Trisch I, Leombroni M, Buca D, et al. Risk factors for abnormally invasive placenta: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2020;33(3):471-81. https://doi.org/10.1080/14767058.2018.1493453
    1. Buca D, Liberati M, Calì G, Forlani F, Caisutti C, Flacco ME, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;52(3):304-9. https://doi.org/10.1002/uog.19070
    1. Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JCA, Singh SS, et al. No. 383-screening, diagnosis, and management of placenta accreta spectrum disorders. J Obstet Gynaecol Can. 2019;41(7):1035-49. https://doi.org/10.1016/j.jogc.2018.12.004

Publication types

LinkOut - more resources