Detection of Placental Disorder Risk: A Literature Review
DOI:
https://doi.org/10.37287/ijghr.v8i6.2861Keywords:
fetal growth restriction, placenta , placenta accreta spectrum, prenatal screening, risk detection, vasa previaAbstract
Placental disorders including preeclampsia, fetal growth restriction (FGR), placenta previa, placental abruption, and placenta accreta spectrum (PAS) are major contributors to maternal and perinatal morbidity and mortality. Early risk detection is crucial for facilitating timely referrals, continuous surveillance, and preventive interventions. This review aims to synthesize recent evidence (2020–2026) regarding the clinical methods and diagnostic tools used to detect the risk of various placental disorders.Methods: A comprehensive literature review was conducted in accordance with the PRISMA 2020 guidelines. Systematic searches were performed across PubMed, ScienceDirect, Scopus, and Google Scholar for studies published between 2020 and 2026. Studies were rigorously screened by title, abstract, and full-text to ensure they met predetermined eligibility criteria. Eight systematic reviews and meta-analyses were included in the final analysis. The findings were categorized into three primary themes: (1) the diagnostic accuracy of ultrasound and MRI for PAS, including the optimal timing of ultrasound screening; (2) the clinical utility of the sFlt-1/PlGF biomarker ratio in detecting FGR; and (3) the incidence rates and identifiable risk factors of vasa previa. Current evidence suggests that ultrasound provides strong diagnostic accuracy for PAS in at-risk women, performing comparably to MRI, while first-trimester scans offer earlier detection albeit with lower specificity. Additionally, the sFlt-1/PlGF ratio serves as a valuable adjunctive tool for FGR detection, and the majority of vasa previa cases present with identifiable risk factors that can be detected during routine prenatal scans.References
American College of Obstetricians and Gynecologists. (2020). Gestational hypertension and preeclampsia: ACOG Practice Bulletin No. 222. Obstetrics & Gynecology, 135(6), e237–e260.
Bertini, A., Salas, R., Chabert, S., Sobrevia, L., & Pardo, F. (2022). Using machine learning to predict complications in pregnancy: A systematic review. Frontiers in Bioengineering and Biotechnology, 9, Article 780389.
Bhide, A., Acharya, G., Baschat, A., et al. (2021). ISUOG Practice Guidelines (updated): Use of Doppler velocimetry in obstetrics. Ultrasound in Obstetrics & Gynecology, 58(2), 331–339.
Chaemsaithong, P., Sahota, D. S., & Poon, L. C. (2022). First trimester preeclampsia screening and prediction. American Journal of Obstetrics and Gynecology, 226(2S), S1071–S1097.
Chen, W., Wei, Q., Liang, Q., Song, S., & Li, J. (2022). Diagnostic capacity of sFlt-1/PlGF ratio in fetal growth restriction: A systematic review and meta-analysis. Placenta, 127, 37–42. https://doi.org/10.1016/j.placenta.2022.07.020
Davidson, L., & Boland, M. R. (2021). Towards deep phenotyping pregnancy: A systematic review on artificial intelligence and machine learning methods to improve pregnancy outcomes. Briefings in Bioinformatics, 22(5), Article bbaa369.
De Oliveira Carniello, M., Oliveira Brito, L. G., Sarian, L. O., & Bennini, J. R. (2022). Diagnosis of placenta accreta spectrum in high-risk women using ultrasonography or magnetic resonance imaging: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 59(4), 428–436.
Dimitriadis, E., Rolnik, D. L., Zhou, W., et al. (2023). Pre-eclampsia. Nature Reviews Disease Primers, 9, Article 8.
Hecht, J. L., Baergen, R., Ernst, L. M., et al. (2020). Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: Recommendations from an expert panel. Modern Pathology, 33(12), 2382–2396.
Hessami, K., Horgan, R., Munoz, J. L., Norooznezhad, A. H., Nassr, A. A., Fox, K. A., Di Mascio, D., Caldwell, M., Catania, V., D’Antonio, F., & Abuhamad, A. Z. (2024). Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 63(6), 723–730.
Hoffman, M. K., Goudar, S. S., Kodkany, B. S., et al. (2020). Low-dose aspirin for the prevention of preterm delivery in nulliparous women with a singleton pregnancy (ASPIRIN): A randomised, double-blind, placebo-controlled trial. The Lancet, 395(10220), 285–293.
Hong, S., Le, Y., Lio, K. U., Zhang, T., Zhang, Y., & Zhang, N. (2022). Performance comparison of ultrasonography and magnetic resonance imaging in their diagnostic accuracy of placenta accreta spectrum disorders: A systematic review and meta-analysis. Insights into Imaging, 13, Article 50. https://doi.org/10.1186/s13244-022-01192-w
Jauniaux, E., Silver, R. M., & Matsubara, S. (2020). The new world of placenta accreta spectrum disorders. International Journal of Gynecology & Obstetrics, 148(1), 1–5.
Jha, P., Pōder, L., Bourgioti, C., et al. (2020). Society of Abdominal Radiology (SAR) and European Society of Urogenital Radiology (ESUR) joint consensus statement for MR imaging of placenta accreta spectrum disorders. European Radiology, 30(5), 2604–2615.
Jung, E., Romero, R., Yeo, L., et al. (2022). The etiology of preeclampsia. American Journal of Obstetrics and Gynecology, 226(2S), S844–S866.
Kapoor, H., Hanaoka, M., Dawkins, A., & Khurana, A. (2021). Review of MRI imaging for placenta accreta spectrum: Pathophysiologic insights, imaging signs, and recent developments. Placenta, 104, 31–39.
Lees, C. C., Stampalija, T., Baschat, A., et al. (2020). ISUOG Practice Guidelines: Diagnosis and management of small-for-gestational-age fetus and fetal growth restriction. Ultrasound in Obstetrics & Gynecology, 56(2), 298–312.
Macedo, T. C. C., Montagna, E., Trevisan, C. M., et al. (2020). Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969. European Journal of Obstetrics & Gynecology and Reproductive Biology, 248, 177–186.
Maged, A. M., El-Mazny, A., Kamal, N., Mahmoud, S. I., Fouad, M., El-Nassery, N., Kotb, A., Ragab, W. S., Ogila, A. I., Metwally, A. A., Lasheen, Y., Fahmy, R. M., Katta, M., Shaeer, E. K., & Salah, N. (2023). Diagnostic accuracy of ultrasound in the diagnosis of placenta accreta spectrum: Systematic review and meta-analysis. BMC Pregnancy and Childbirth, 23, Article 354. https://doi.org/10.1186/s12884-023-05675-6
Magee, L. A., Brown, M. A., Hall, D. R., et al. (2022). The 2021 International Society for the Study of Hypertension in Pregnancy classification, diagnosis & management recommendations for international practice. Pregnancy Hypertension, 27, 148–169.
Matsuzaki, S., Ueda, Y., Matsuzaki, S., Kakuda, M., Lee, M., Takemoto, Y., Hayashida, H., Maeda, M., Kakubari, R., Hisa, T., Mabuchi, S., & Kamiura, S. (2022). The characteristics and obstetric outcomes of type II vasa previa: Systematic review and meta-analysis. Biomedicines, 10(12), Article 3263. https://doi.org/10.3390/biomedicines10123263
Melamed, N., Baschat, A., Yinon, Y., et al. (2021). FIGO (International Federation of Gynecology and Obstetrics) initiative on fetal growth: Best practice advice for screening, diagnosis, and management of fetal growth restriction. International Journal of Gynecology & Obstetrics, 152(S1), 3–57.
Melchiorre, K., Thilaganathan, B., Giorgione, V., et al. (2020). Hypertensive disorders of pregnancy and future cardiovascular health. Frontiers in Cardiovascular Medicine, 7, Article 59.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., ... Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, Article n71.
Palacios-Jaraquemada, J. M., Fiorillo, A., Hamer, J., Martínez, M., & Bruno, C. (2022). Placenta accreta spectrum: A hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. The Journal of Maternal-Fetal & Neonatal Medicine, 35(2), 275–282.
Pavalagantharajah, S., Villani, L. A., & D’Souza, R. (2020). Vasa previa and associated risk factors: A systematic review and meta-analysis. American Journal of Obstetrics & Gynecology MFM, 2(3), Article 100117. https://doi.org/10.1016/j.ajogmf.2020.100117
Rana, S., Burke, S. D., & Karumanchi, S. A. (2022). Imbalances in circulating angiogenic factors in the pathophysiology of preeclampsia and related disorders. American Journal of Obstetrics and Gynecology, 226(2S), S1019–S1034.
Redman, C. W., Staff, A. C., & Roberts, J. M. (2022). Syncytiotrophoblast stress in preeclampsia: The convergence point for multiple pathways. American Journal of Obstetrics and Gynecology, 226(2S), S907–S927.
Rolnik, D. L., Nicolaides, K. H., & Poon, L. C. (2022). Prevention of preeclampsia with aspirin. American Journal of Obstetrics and Gynecology, 226(2S), S1108–S1119.
Shainker, S. A., Coleman, B., Timor-Tritsch, I. E., et al. (2021). Special report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. American Journal of Obstetrics and Gynecology, 224(1), B2–B14.
Sovio, U., Goulding, N., McBride, N., et al. (2020). A maternal serum metabolite ratio predicts fetal growth restriction at term. Nature Medicine, 26(3), 348–353.
Staff, A. C., Fjeldstad, H. E., Fosheim, I. K., et al. (2022). Failure of physiological transformation and spiral artery atherosis: Their roles in preeclampsia. American Journal of Obstetrics and Gynecology, 226(2S), S895–S906.
Stepan, H., Galindo, A., Hund, M., et al. (2023). Clinical utility of sFlt-1 and PlGF in screening, prediction, diagnosis and monitoring of pre-eclampsia and fetal growth restriction. Ultrasound in Obstetrics & Gynecology, 61(2), 168–180.
Thadhani, R., Lemoine, E., Rana, S., et al. (2022). Circulating angiogenic factor levels in hypertensive disorders of pregnancy. NEJM Evidence, 1(12).
Tinari, S., Buca, D., Cali, G., et al. (2021). Risk factors, histopathology and diagnostic accuracy in posterior placenta accreta spectrum disorders: Systematic review and meta-analysis. Ultrasound in Obstetrics & Gynecology, 57(6), 903–909.
Wang, W., Xie, X., Yuan, T., et al. (2021). Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: A population-based study. BMC Pregnancy and Childbirth, 21, Article 364.
Wright, D., Wright, A., & Nicolaides, K. H. (2020). The competing risk approach for prediction of preeclampsia. American Journal of Obstetrics and Gynecology, 223(1), 12–23.e7.
Zhang, W., Giacchino, T., Chanyarungrojn, P. A., Ionescu, O., & Akolekar, R. (2023). Incidence of vasa praevia: A systematic review and meta-analysis. BMJ Open, 13(9), Article e075245. https://doi.org/10.1136/bmjopen-2023-075245
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
