Comparison of maternal outcomes and clinical characteristics of prenatally vs nonprenatally diagnosed placenta accreta spectrum: a systematic review and meta-analysis

OBJECTIVE This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. DATA SOURCES A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022. STUDY ELIGIBILITY CRITERIA Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa. METHODS Study screening was performed after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. RESULTS Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21–0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02–3.83), lower blood loss volume (mean difference, −0.65; 95% confidence interval, −1.17 to −0.13), and lower number of transfused red blood cell units (mean difference, −1.96; 95% confidence interval, −3.25 to −0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10–0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12–11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06–0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24–7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12–11.25) showed statistical significance. No significant difference was found for the other outcomes. CONCLUSION Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline. This study aimed to compare maternal outcomes of prenatally and nonprenatally diagnosed placenta accreta spectrum. A systematic literature search was performed in PubMed, the Cochrane database, and Web of Science until November 28, 2022. Studies comparing the clinical presentation of prenatally and nonprenatally diagnosed placenta accreta spectrum were included. The primary outcomes were emergent cesarean delivery, hysterectomy, blood loss volume, number of transfused blood product units, urological injury, coagulopathy, reoperation, intensive care unit admission, and maternal death. In addition, the pooled mean values for blood loss volume and the number of transfused blood product units were calculated. The secondary outcomes included maternal age, gestational age at birth, nulliparity, previous cesarean delivery, previous uterine procedure, assisted reproductive technology, placenta increta and percreta, and placenta previa. Study screening was performed after duplicates were identified and removed. The quality of each study and the publication bias were assessed. Forest plots and I2 statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. Overall, 415 abstracts and 157 full-text studies were evaluated. Moreover, 31 studies were analyzed. Prenatally diagnosed placenta accreta spectrum was associated with a significantly lower rate of emergency cesarean delivery (odds ratio, 0.37; 95% confidence interval, 0.21–0.67), higher hysterectomy rate (odds ratio, 1.98; 95% confidence interval, 1.02–3.83), lower blood loss volume (mean difference, −0.65; 95% confidence interval, −1.17 to −0.13), and lower number of transfused red blood cell units (mean difference, −1.96; 95% confidence interval, −3.25 to −0.68) compared with nonprenatally diagnosed placenta accreta spectrum. The pooled mean values for blood loss volume and the number of transfused blood product units tended to be lower in the prenatally diagnosed placenta accreta spectrum groups than in the nonprenatally diagnosed placenta accreta spectrum groups. Nulliparity (odds ratio, 0.14; 95% confidence interval, 0.10–0.20), previous cesarean delivery (odds ratio, 6.81; 95% confidence interval, 4.12–11.25), assisted reproductive technology (odds ratio, 0.19; 95% confidence interval, 0.06–0.61), placenta increta and percreta (odds ratio, 3.97; 95% confidence interval, 2.24–7.03), and placenta previa (odds ratio, 6.81; 95% confidence interval, 4.12–11.25) showed statistical significance. No significant difference was found for the other outcomes. Despite its severity, the positive effect of prenatally diagnosed placenta accreta spectrum on outcomes underscores the necessity of a prenatal diagnosis. In addition, the pooled mean values provide a preoperative preparation guideline.