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Improving Early Pregnancy Screening for Placenta Accreta Spectrum: Retrospective Analysis of Early Screening Candidates by Risk Assessment in Canada

Published:March 21, 2022DOI:https://doi.org/10.1016/j.jogc.2022.03.006

      Abstract

      Early screening for placenta accreta spectrum (PAS) is not established in Canada, yet has been demonstrated with a 2-stage strategy in patients classified as at risk at the nuchal translucency examination. We performed a retrospective analysis of women with singleton pregnancies who had first-trimester screening and subsequently had a pathology-confirmed PAS. We sought those who met high-risk clinical criteria for PAS: previous uterine surgeries and an anterior low-lying placenta. Over 80% of women met both high-risk criteria at the nuchal translucency examination. Lack of early recognition and risk stratification resulted in a late median gestational age at suspicion and diagnosis of PAS.

      Résumé

      Il n’existe aucun protocole de dépistage précoce du placenta du spectre accreta (PSA) au Canada. Toutefois, il s’avère efficace dans une stratégie en deux étapes chez les patientes à risque selon les observations à l’examen de la clarté nucale. Nous avons effectué une analyse rétrospective de femmes ayant subi un dépistage au premier trimestre en contexte de grossesse monofśtale puis reçu un diagnostic confirmé de PSA. Nous avons ciblé les patientes répondant aux critères cliniques de risque élevé de PSA, notamment celles avec antécédent de chirurgie utérine et un placenta bas inséré antérieur. Plus de 80 % de ces femmes répondaient aux deux critères lors de l’examen de la clarté nucale. L’absence de détection précoce et de classification du risque a fait en sorte que le PSA a été soupçonné et diagnostiqué à un âge gestationnel médian avancé.

      Keywords

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