Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders

Grigory A. Penzhoyan; Tatiana B. Makukhina

doi:10.1515/jpm-2019-0261

Article

Significance of the routine first-trimester antenatal screening program for aneuploidy in the assessment of the risk of placenta accreta spectrum disorders

Grigory A. Penzhoyan and Tatiana B. Makukhina

Published/Copyright: November 14, 2019

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From the journal Journal of Perinatal Medicine Volume 48 Issue 1

Abstract

Objective

To select a group at high risk of placenta accreta spectrum disorders (PAS) based on the data of serum screening in the first trimester.

Methods

A retrospective analysis of 48 patients with abnormal placental location (AP), including placenta previa (PP) only (n = 23) and PP and PAS (n = 25), was performed. Additionally, the AP group was divided depending on the blood loss volume: not higher than 1000 mL (LBL) (n = 29) and higher than 1000 mL (HBL) (n = 19); diagnostic term of PAS by ultrasound, data pregnancy-associated plasma protein-A (РAРР-A) and free β subunit of human chorionic gonadotropin (free β-hCG) multiple of median (MоM) at 11⁺⁰–13⁺⁶ weeks of gestation were evaluated. Serological markers were compared with the data of 39 healthy pregnant women with scar after previous cesarean section and normal placental location (control).

Results

The mean gestation at diagnostic term of PAS was 29 weeks. PAPP-Р MоM [mean (M) ± standard deviation (SD)] was: in controls, 1.07 ± 0.47; in the AP group, 1.59 ± 0.24; in PP, 1.91 ± 1.52; in PAS, 1.30 ± 0.85; in LBL, 1.37 ± 1.20; in HBL, 1.91 ± 1.24. The difference between control/AP, control/PP, control/PAS, PP/PAS, control/LBL, control/HBL and LBL/HBL was Р = 0.256, 0.145, 0.640, 0.311, 0.954, 0.025 and 0.09, respectively. Free β-hCG MoM (M ± SD) was: in controls, 1.08 ± 0.69, in AP, 1.31 ± 0.96; in PP, 1.46 ± 0.19; in PAS, 1.16 ± 0.65; in LBL, 1.30 ± 0.06; in HBL, 1.32 ± 0.78. Comparison of free β-hCG AP with controls and between subgroups did not reveal a significant difference.

Conclusion

Underestimation of PAS risk factors in pregnant women with AP leads to late diagnostics of pathology only in the third trimester. The assessment of the РAРР-A level in the first trimester may be helpful for the early prognosis of pathological blood loss at delivery for pregnant women with AP and for forming the high-risk group for PAS.

Keywords: placenta accreta spectrum disorders; placenta previa; pregnancy-associated plasma protein-A (PAPP-A); serological markers of aneuploidy first trimester.; ultrasound examination

Corresponding author: Assoc. Prof. Tatiana B. Makukhina, Federal State Budgetary Educational Institution of Higher Education, “Kuban State Medical University” of the Ministry of Healthcare of the Russian Federation, Obstetrics, Gynecology and Perinatology, Department for Postgraduate Education, M. Sedina Str., 4, Krasnodar 350063, Russia

Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Zosmer N, Fuller J, Shaikh H, Johns J, Ross JA. Natural history of early first-trimester pregnancies implanted in cesarean scars. Ultrasound Obstet Gynecol 2015;46:367–75.10.1002/uog.14775Search in Google Scholar PubMed

2. Cali G, Forlani F, Foti F, Minneci G, Manzoli L, Flacco ME, et al. Diagnostic accuracy of first-trimester ultrasound in detecting abnormally invasive placenta in high-risk women with placenta previa. Ultrasound Obstet Gynecol 2018;52:258–64.10.1002/uog.19045Search in Google Scholar PubMed

3. Panaiotova J, Tokunaka M, Krajewska K, Zosmer N, Nicolaides KH. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet Gynecol 2019;53:101–6.10.1002/uog.20104Search in Google Scholar PubMed

4. Thompson O, Otigbah C, Nnochiri A, Sumithran E, Spencer K. First trimester maternal serum biochemical markers of aneuploidy in pregnancies with abnormally invasive placentation. BJOG 2015;122:1370–6.10.1111/1471-0528.13298Search in Google Scholar PubMed

5. Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am J Obstet Gynecol 2017;217:27–36.10.1016/j.ajog.2017.02.050Search in Google Scholar PubMed

6. Penzhoyan GA, Makukhina TB, Mingaleva NV, Solntseva AV, Amirkhanyan AM. Management of patients with abnormal invasive placenta in different gestation age. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie [Obstetrics and Gynecology: News, Opinions, Training] 2019;7:79–84. DOI: 10.24411/2303-9698-2019-11011 (in Russian).10.24411/2303-9698-2019-11011Search in Google Scholar

7. Desai N, Krantz D, Roman A, Fleischer A, Boulis S, Rochelson B. Elevated first trimester PAPP-A is associated with increased risk of placenta accrete. Prenat Diagn 2014;34:159–62.10.1002/pd.4277Search in Google Scholar PubMed

8. Lyell DJ, Faucett AM, Baer RJ, Blumenfeld YJ, Druzin ML, El-Sayed YY, et al. Maternal serum markers, characteristics and morbidly adherent placenta in women with previa. J Perinatol 2015;35:570–4.10.1038/jp.2015.40Search in Google Scholar PubMed

9. Jauniaux E, Alfirevic Z, Bhide AG, Belfort MA, Burton GJ, Collins SL, et al. Placenta praevia and placenta accreta: diagnosis and management. Green-top Guideline No. 27a. BJOG 2019;126:e1–48.10.1111/1471-0528.15306Search in Google Scholar PubMed

10. Jauniaux E, Bhide A, Kennedy A, Woodward P, Hubinont C, Collins S. FIGO consensus guidelines on placenta accreta spectrum disorders: prenatal diagnosis and screening. Int J Gynecol Obstet 2018;140:274–80.10.1002/ijgo.12408Search in Google Scholar PubMed

11. Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol 2013;39:1958–65.10.1016/j.ultrasmedbio.2013.05.017Search in Google Scholar PubMed

12. D’Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L, Bhide A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014;44:8–16.10.1002/uog.13327Search in Google Scholar PubMed

Received: 2019-07-16

Accepted: 2019-10-17

Published Online: 2019-11-14

Published in Print: 2019-12-18

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Articles in the same Issue

https://doi.org/10.1515/jpm-2019-0261

Keywords for this article

placenta accreta spectrum disorders; placenta previa; pregnancy-associated plasma protein-A (PAPP-A); serological markers of aneuploidy first trimester.; ultrasound examination