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Development of a training program for the ultrasound screening of placenta accreta spectrum disorders

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Ivelina Dimitrova, Eric Jauniaux, Nurit Zosmer, Luciana Bocchi De Stefani, Walkyria Andrade, Elli Bourmpaki, Catherine Victoria Bunce, Kypros H. Nicolaides

Original languageEnglish
Article number147
Pages (from-to)73-77
Number of pages5
JournalInternational Journal of Gynecology & Obstetrics
Issue number1
Early online date2 Jul 2019
Publication statusPublished - 1 Oct 2019


King's Authors


Objective To evaluate the impact of a training program using a systematic protocol on ultrasound signs of placenta accreta spectrum (PAS). Methods Intra‐ and inter‐observer variability rates and sensitivity were tested, before and after additional training, by two research fellows with a prior basic training in obstetric ultrasound using digitally recorded second‐trimester ultrasound images from cases of anterior placenta previa with and without PAS. Results Fifty‐two cases of anterior placenta previa with PAS (n=26) and without PAS (n=26) were included in the study. The highest level of inter‐observer agreement for ultrasound signs was found for the absence of placental bulge and/or focal exophytic mass on gray‐scale imaging and the absence of subplacental hypervascularity, bridging vessels and lacunar feeder vessels on color Doppler imaging. The level of inter‐observer agreement increased from 39% before training to 40% after training; the numbers agreed as PAS by both trainees increased from four to 20. No cases were classified as inconclusive after training. There was a significant (P<0.001) change in sensitivity for both trainees after training. Conclusion Additional training in detecting the ultrasound signs associated with PAS using a standardized protocol improves the diagnostic accuracy of operators with only a basic obstetric ultrasound training.

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