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Placenta Accreta SpectrumNCT05500404

Diagnostic Accuracy of Placental Thickness in Lower Uterine Segment Measured By Ultrasound in Prediction of Placenta Accreta Spectrum in Patients With Placenta Previa. A Diagnostic Test Accuracy Study

An observational study of Placenta Accreta Spectrum, run by Ain Shams Maternity Hospital at 1 site in Egypt.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Current prenatal diagnosis of placenta accrete spectrum disorders relies on subjective individual interpretations of visual sonographic findings on grayscale and color Doppler imaging. When blinded to clinical data, there is significant interobserver variability in the diagnosis of invasive placentation. Read more about this study

Who is it for?
Ages 20 to 40 years, women only
Conditions the study is for
Placenta Accreta Spectrum
What is being tested?
Ultrasound measurment of placental thickness
How many people
40 participants
Where
1 siteEgypt
Study dates
1 Dec 2021to 31 Aug 2022
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 20 to 40 years
  • Women only
  • No healthy volunteers
  • Adult

Study population: Pregnant women with placenta Previa attending outpatient obstetric clinic at Ain Shams University Maternity Hospital

Who may be able to join

  • Pregnant women with ultrasound diagnosis of placenta previa or low lying placenta
  • Gestational age above 26 weeks
  • singleton pregnancy
  • fetal life positive
  • Past history of cesarean section regardless of the number

Who cannot join

  • Hemodynamically unstable women.
  • Patients with pregestational or gestational DM.
  • Multiple gestation.
  • Medical disorders which can lead to uteroplacental insufficiency (preeclampsia - SLE - antiphospholipid antibody syndrome).
  • Any condition which can lead to enlarged placenta such as fetal hydrops

Trial locations and contacts

1 site in 1 country.

Egypt1 site

  • AinShams university maternity hospital

    Cairo

Other trials in Egypt

About this study

Current prenatal diagnosis of placenta accrete spectrum disorders relies on subjective individual interpretations of visual sonographic findings on grayscale and color Doppler imaging. When blinded to clinical data, there is significant interobserver variability in the diagnosis of invasive placentation.

This study will evaluate placental thickness among pregnant women with placenta previa and determine if increased placenta thickness correlates with the risk for placenta accreta spectrum (PAS) disorders.

Read the detailed description

Placenta accreta spectrum is one of the most dangerous conditions associated with pregnancy, because hemorrhage may result in multisystem organ failure, disseminated intravascular coagulation, need for admission to an intensive care unit, hysterectomy, and even death. The reported incidence of placenta accrete spectrum disorder has increased over time and is currently between 1 in 533 to 1 in 300 pregnancies. Prior cesarean delivery and especially multiple cesarean deliveries are major risk factors. The spectrum includes placenta accreta (attachment of the placenta to myometrium without intervening decidua), placenta increta (invasion of the trophoblast into the myometrium), and placenta percreta (invasion through the myometrium, serosa, and into surrounding structures). PAS is linked to placenta previa, and there is a lot of overlap in imaging findings between the two processes. PAS problems affect approximately 11% of people with placenta previa. Differentiating between placenta previa with and without PAS problems is crucial in clinical practice. A finding of placenta previa together with a history of cesarean delivery has long been an indication for counseling patients on their risk of PAS in a current pregnancy, as the risk for placenta accreta in the presence of placenta previa increases with each subsequent cesarean delivery. Aside from cesarean deliveries and placenta previa, other risk factors have been identified for PAS, including past uterine surgeries, in vitro fertilization (IVF), multiparity, maternal age, and even female sex of the infant. Prenatal diagnosis of AIP has been shown to reduce maternal morbidity associated with this condition, most likely due to the opportunity to plan management in advance. Ultrasound is the primary investigation for prenatal diagnosis of morbidly adherent placenta, and the diagnostic accuracy is good both in retrospective, as well as prospective case series. Placental localization with transabdominal sonography (TAS) has been a standard practice for a long time. Despite its availability and noninvasive nature, accuracy of TAS may be limited by many factors, such as the posterior implantation of placenta, being obscured by the fetal head, an under-filled or over-distended bladder, and presence of blood clots, fibroids, uterine contractions, and obesity. These limitations are overcome by transvaginal sonography (TVS), which provides a better resolution by using a higher frequency transducer, shorter distance from the transducer to the internal os, and is not affected by the over- or under-filling of the bladder. Although ultrasonography's sensitivity and specificity for detecting accreta have been reported to be excellent, ranging from 80 to 90%, there was considerable difference among "experts" in predicting whether PAS was present. With placental implantation into the cesarean section scar, the center of the placental disc would be in the vicinity of the lower uterine scar. If placental implantation was near the scar but not in it, only the thinner placental margin might encroach into the lower uterine segment. The investigators therefore hypothesized that the placenta is thicker with AIP in women with a low-lying placenta or placenta previa. So, the investigators hypothesize that placental thickness will be directly related to placental invasion in cases of placenta accrete spectrum.

Being tested
Ultrasound measurment of placental thickness
Medical subject headings
Placenta Accreta

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ultrasound measurment of placental thicknessDiagnostic test

    The maximum placental thickness in the lower uterine segment will obtained using trans-abdominal ultrasound scan. For the image to be deemed suitable, a midline sagittal section of the lower uterine segment (with the implanted placenta) and the cervical canal, with the intervening urinary bladder will be required (Bhide et al., 2019). The measurement will be performed by a researcher who will be blinded to the final diagnosis.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Placental thickness threshold

    Threshold of placental thickness which can be used as cutoff level with appropriate sensitivity and specificity so it can be used as a screening test for such morbid condition.

    Measured: after 26 weeks of pregnancy

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Aug 2022
  2. Study start1 Dec 2021
  3. Primary completion31 Aug 2022
  4. Study completion31 Aug 2022

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05500404
Sponsor's protocol ID
5
Status last verified
Nov 2022
First submitted
11 Aug 2022
Last updated
23 Nov 2022
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018 Apr 19;378(16):1529-1536. doi: 10.1056/NEJMcp1709324. No abstract available.

    PubMed 29669225

  • Li Y, Choi HH, Goldstein R, Poder L, Jha P. Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa. Abdom Radiol (NY). 2021 Jun;46(6):2722-2728. doi: 10.1007/s00261-020-02894-9. Epub 2021 Jan 2.

    PubMed 33388802

  • Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018 Jan;218(1):75-87. doi: 10.1016/j.ajog.2017.05.067. Epub 2017 Jun 24.

    PubMed 28599899

  • Morgan EA, Sidebottom A, Vacquier M, Wunderlich W, Loichinger M. The effect of placental location in cases of placenta accreta spectrum. Am J Obstet Gynecol. 2019 Oct;221(4):357.e1-357.e5. doi: 10.1016/j.ajog.2019.07.028. Epub 2019 Jul 22.

    PubMed 31344349

  • Bhide A, Laoreti A, Kaelin Agten A, Papageorghiou A, Khalil A, Uprichard J, Thilaganathan B, Chandraharan E. Lower uterine segment placental thickness in women with abnormally invasive placenta. Acta Obstet Gynecol Scand. 2019 Jan;98(1):95-100. doi: 10.1111/aogs.13422. Epub 2018 Aug 2.

    PubMed 29978457

  • Petpichetchian C, Pranpanus S, Suntharasaj T, Kor-Anantakul O, Hanprasertpong T. Comparison of transabdominal and transvaginal sonography in the diagnosis of placenta previa. J Clin Ultrasound. 2018 Jul;46(6):386-390. doi: 10.1002/jcu.22600. Epub 2018 Apr 25.

    PubMed 29693718

  • Elmaraghy AM, Taha Fayed S, Abd ElHamid Ali M, Ali Hassanien M, Mohamed Mamdouh A. Diagnostic Accuracy of Placental Thickness in Lower Uterine Segment Measured by Ultrasound in Prediction of Placenta Accreta Spectrum in Patients with Placenta Previa. A Diagnostic Test Accuracy Study. Int J Womens Health. 2023 Feb 16;15:311-320. doi: 10.2147/IJWH.S399520. eCollection 2023.

    PubMed 36814526

Questions about this trial

What is this clinical trial studying?

An observational study of Placenta Accreta Spectrum, run by Ain Shams Maternity Hospital at 1 site in Egypt.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 5 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 23 Nov 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Placental thickness threshold (time frame: after 26 weeks of pregnancy). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05500404, which also lists 7 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 23 Nov 2022.

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