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Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta‐analysis
Author(s) -
Buca D.,
Liberati M.,
Calì G.,
Forlani F.,
Caisutti C.,
Flacco M. E.,
Manzoli L.,
Familiari A.,
Scambia G.,
D'Antonio F.
Publication year - 2018
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19070
Subject(s) - medicine , odds ratio , obstetrics , prenatal diagnosis , urinary system , gestational age , pregnancy , meta analysis , intensive care unit , prenatal care , amniocentesis , pediatrics , fetus , population , biology , genetics , environmental health
Objective To ascertain the impact of prenatal diagnosis on surgical outcome of women affected by abnormally invasive placenta (AIP). Methods MEDLINE, EMBASE, CINAHL and Cochrane databases were searched. Observed outcomes included: gestational age at birth (weeks), amount of blood loss (L), units of red blood cells (RBC), platelets (PLT) and fresh frozen plasma (FFP) transfused, length of stay in hospital and the intensive care unit (ICU) (days), urinary tract injury and infection. Only studies reporting the occurrence of any of the explored outcomes in women with a prenatal compared with an intrapartum diagnosis of AIP were considered eligible for inclusion. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Results Thirteen studies were included. Women with a prenatal diagnosis of AIP had less blood loss during surgery (mean difference (MD), −0.87; 95% CI, −1.5 to −0.23), had fewer units of RBC (MD, −1.45; 95% CI, −2.9 to −0.04) and FFP (MD, −1.73; 95% CI, −3.3 to −0.2) transfused, and delivered earlier (MD, 1.33 weeks; 95% CI, −2.23 to −0.43) compared with those with an intrapartum diagnosis. The risk of admission to an ICU and length of in‐hospital and in‐ICU stay were not different between the groups. Prenatal diagnosis of AIP was associated with a higher risk of urinary‐tract injury (odds ratio, 2.5; 95% CI, 1.3–4.6), mainly due to the higher prevalence of placenta percreta in the group with AIP diagnosed prenatally. Conclusion Prenatal diagnosis of AIP is associated with reduced hemorrhagic morbidity compared with cases in which such anomalies are detected at delivery. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.