Epidemiology of placenta previa accreta: a systematic review and meta-analysis
Objective To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis.Design Systematic review and meta-analysis.Data sources PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were...
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BMJ Publishing Group
2019-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/11/e031193.full |
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| author | Catey Bunce Eric Jauniaux Lene Grønbeck Jens Langhoff-Roos Sally L Collins |
| author_facet | Catey Bunce Eric Jauniaux Lene Grønbeck Jens Langhoff-Roos Sally L Collins |
| author_sort | Catey Bunce |
| collection | DOAJ |
| description | Objective To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis.Design Systematic review and meta-analysis.Data sources PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018.Eligibility criteria Studies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population.Data extraction and synthesis Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth.Results A total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39–1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05–0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65–17.35).Conclusions The high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness.PROSPERO registration number CRD42017068589 |
| format | Article |
| id | doaj-art-b7b608ed3f4a4e13a242e9969207aafb |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-b7b608ed3f4a4e13a242e9969207aafb2025-08-20T02:27:43ZengBMJ Publishing GroupBMJ Open2044-60552019-11-0191110.1136/bmjopen-2019-031193Epidemiology of placenta previa accreta: a systematic review and meta-analysisCatey Bunce0Eric Jauniaux1Lene Grønbeck2Jens Langhoff-Roos3Sally L Collins4King’s College LondonEGA Institute for Women Health, University College London, London, UK2 Department of Obstetrics, Rigshospitalet, University of Copenhagen, Kobenhavns, Denmark4 Departement of Obstetrics, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark5 Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, UKObjective To estimate the prevalence and incidence of placenta previa complicated by placenta accreta spectrum (PAS) and to examine the different criteria being used for the diagnosis.Design Systematic review and meta-analysis.Data sources PubMed, Google Scholar, ClinicalTrials.gov and MEDLINE were searched between August 1982 and September 2018.Eligibility criteria Studies reporting on placenta previa complicated by PAS diagnosed in a defined obstetric population.Data extraction and synthesis Two independent reviewers performed the data extraction using a predefined protocol and assessed the risk of bias using the Newcastle-Ottawa scale for observational studies, with difference agreed by consensus. The primary outcomes were overall prevalence of placenta previa, incidence of PAS according to the type of placenta previa and the reported clinical outcomes, including the number of peripartum hysterectomies and direct maternal mortality. The secondary outcomes included the criteria used for the prenatal ultrasound diagnosis of placenta previa and the criteria used to diagnose and grade PAS at birth.Results A total of 258 articles were reviewed and 13 retrospective and 7 prospective studies were included in the analysis, which reported on 587 women with placenta previa and PAS. The meta-analysis indicated a significant (p<0.001) heterogeneity between study estimates for the prevalence of placenta previa, the prevalence of placenta previa with PAS and the incidence of PAS in the placenta previa cohort. The median prevalence of placenta previa was 0.56% (IQR 0.39–1.24) whereas the median prevalence of placenta previa with PAS was 0.07% (IQR 0.05–0.16). The incidence of PAS in women with a placenta previa was 11.10% (IQR 7.65–17.35).Conclusions The high heterogeneity in qualitative and diagnostic data between studies emphasises the need to implement standardised protocols for the diagnoses of both placenta previa and PAS, including the type of placenta previa and grade of villous invasiveness.PROSPERO registration number CRD42017068589https://bmjopen.bmj.com/content/9/11/e031193.full |
| spellingShingle | Catey Bunce Eric Jauniaux Lene Grønbeck Jens Langhoff-Roos Sally L Collins Epidemiology of placenta previa accreta: a systematic review and meta-analysis BMJ Open |
| title | Epidemiology of placenta previa accreta: a systematic review and meta-analysis |
| title_full | Epidemiology of placenta previa accreta: a systematic review and meta-analysis |
| title_fullStr | Epidemiology of placenta previa accreta: a systematic review and meta-analysis |
| title_full_unstemmed | Epidemiology of placenta previa accreta: a systematic review and meta-analysis |
| title_short | Epidemiology of placenta previa accreta: a systematic review and meta-analysis |
| title_sort | epidemiology of placenta previa accreta a systematic review and meta analysis |
| url | https://bmjopen.bmj.com/content/9/11/e031193.full |
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