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Review
. 2025 Feb 24;5(2):100467.
doi: 10.1016/j.xagr.2025.100467. eCollection 2025 May.

Accuracy of ultrasound in prediction of abnormal placental adherence: a systematic review and meta-analysis

Ekramy A Mohamed  1 , Ruqayyah Ali Ahmed  2 , Nada Yasser Metwali  2 , Jumana Hussain Timraz  2 , Ahmed Mohamed  3 , Hossam Abdelfatah Mansour  4
Affiliations
Review

Accuracy of ultrasound in prediction of abnormal placental adherence: a systematic review and meta-analysis

Ekramy A Mohamed et al. AJOG Glob Rep. .

Abstract

Background: The accuracy of ultrasound in detecting invasive placentation, such as placenta accreta spectrum (PAS), remains a topic of debate. Accurate prenatal diagnosis is crucial to improve maternal outcomes, especially in women with high-risk factors..

Objective: This systematic review and meta-analysis aimed to evaluate the diagnostic accuracy of ultrasonography in predicting invasive placentation among at-risk pregnant women.

Study design: A comprehensive search of multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) was conducted to identify studies assessing the diagnostic accuracy of ultrasound in detecting PAS. A total of 24 studies, including 1,509 high-risk pregnancies, met the inclusion criteria. Data on sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR) were extracted and analyzed.

Results: The meta-analysis demonstrated that ultrasound has a high diagnostic performance, with a pooled sensitivity of 91.73% (95% CI: 88.3-94.7%) and specificity of 97.95% (95% CI: 97.4-98.6%). The DOR was 99.6 (95% CI: 49.9-200.1). Among ultrasound modalities, color Doppler showed the highest predictive accuracy with a sensitivity of 91.75% (95% CI: 86.3-95.6%) and specificity of 87.69% (95% CI: 85.7-91.5%).

Conclusion: Ultrasound, especially with the use of color Doppler, is highly effective in the prenatal diagnosis of PAS disorders in high-risk pregnancies. Early detection through ultrasound allows for better clinical management, reducing maternal morbidity by enabling planned interventions.

Keywords: color Doppler; placenta accreta spectrum; prenatal diagnosis; ultrasound.

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Figure 1
Flow chart of the search and screening process
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