Abstract
Background: Antenatal diagnosis of placenta accreta is important because it could possibly reduce the morbidities. Several attempts including ultrasound, magnetic resonance imaging (MRI), multi-parameter prediction, and cell-free placental mRNA had been studied to establish a good predictor for diagnosis of placenta accreta. We aim to appraise several studies finding at the accuracy value of these predictors. Methods: The search was conducted on the Cochrane Library®, PubMed® and EMBASE® with the keywords of “ultrasound”, “accreta”, and “predict” or “predictor” or “predicting”. We used diagnostic appraisal questions developed by Centre of Evidence-Based Medicine (CEBM), University of Oxford. Result: Appraisal of 8 diagnostic studies involving 1324 patients underwent ultrasound, MRI, cell-free mRNA examination, or their combination for predicting placenta accreta was conducted finding at the diagnostic values. The overall rate of placenta accreta found on these studies were ranging from 8.4% to 31.8%. Accuracy, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of ultrasound in this study in diagnosing placenta accreta were respectively 64.8% – 95.3%, 17% - 100%, 78.9%-100%, 56%-100%, and 64,8% - 100%. The Se, Sp, PPV, and NPV of MRI in predicting placenta accreta derived from 3 studies were respectively 88.89%-100%, 100%, 100%, 92.86%-100%. Se, Sp, PPV, and NPV of cell-free placental mRNA for placenta accreta prediction were respectively. 91.7%, 78.9%, 57.9% and 96.8% using the multiple of median (MoM) of 3.325 as the cut-off point. Conclusion: Ultrasound has a wide range of diagnostic accuracy in predicting placenta accreta. MRI had better diagnostic accuracy for predicting the stage of invasion of placenta. Free-placental mRNA is an objective and promising predictor for diagnosis of placenta accreta.
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