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K H Nicolaides - One of the best experts on this subject based on the ideXlab platform.
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prediction of stillbirth from placental growth factor at 19 24 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: J E Aupont, Ranjit Akolekar, A Illian, S Neonakis, K H NicolaidesAbstract:Objectives To investigate whether the addition of maternal serum placental growth factor (PlGF) measured at 19–24 weeks' gestation improves the performance of screening for stillbirth that is achieved by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) and to evaluate the performance of screening with this model for all stillbirths and those due to impaired Placentation and unexplained or other causes. Methods This was a prospective screening study of 70 003 singleton pregnancies including 268 stillbirths, carried out in two phases. The first phase included prospective measurement of UtA-PI and fetal biometry, which were available in all cases. The second phase included prospective measurement of maternal serum PlGF, which was available for 9870 live births and 86 antepartum stillbirths. The values of PlGF obtained from this screening study were simulated in the remaining cases based on bivariate Gaussian distributions, defined by the mean and standard deviations. Multivariable logistic regression analysis was used to determine whether the addition of maternal serum PlGF improved the performance of screening that was achieved by a combination of maternal factors, fetal biometry and UtA-PI. Results Significant contribution to the prediction of stillbirth was provided by maternal factor-derived a-priori risk, multiples of the median values of PlGF, UtA-PI and fetal biometry Z-scores. A model combining these variables predicted 58% of all stillbirths and 84% of those due to impaired Placentation, at a false-positive rate of 10%. Within the impaired-Placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (97% vs 61%; P < 0.01). Conclusions A high proportion of stillbirths due to impaired Placentation can be identified effectively in the second trimester of pregnancy using a combination of maternal factors, fetal biometry, uterine artery Doppler and maternal serum PlGF. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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prediction of stillbirth from maternal factors fetal biometry and uterine artery doppler at 19 24 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mayumi Tokunaka, Nelson Ortega, Argyro Syngelaki, K H NicolaidesAbstract:Objectives To evaluate the performance of screening for all stillbirths and those due to impaired Placentation and unexplained or other causes by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UT-PI) at 19–24 weeks’ gestation and compare this performance to that of screening by UT-PI alone. Methods This was a prospective screening study of 70,003 singleton pregnancies including 69,735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired Placentation and 109 (41%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UT-PI. Results Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired Placentation and 23% of those that were due to other causes or unexplained, at false positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth at <32 weeks’ gestation was higher than that of stillbirth at ≥37 weeks (88% vs 46%; p < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UT-PI being above the 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired Placentation and 15% of those that were due to other causes or unexplained. Conclusions Second-trimester screening by a combination of UT-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and in particular those due to impaired Placentation.
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prediction of stillbirth from placental growth factor at 11 13 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mirian Machuca, M Mendes, V Paschos, K H NicolaidesAbstract:OBJECTIVES: To investigate whether the addition of maternal serum placental growth factor (PlGF) measured at 11-13 weeks' gestation improves the performance of screening for stillbirths that is achieved by a combination of maternal factors and first-trimester biomarkers such as maternal serum pregnancy-associated plasma protein-A (PAPP-A), fetal ductus venosus pulsatility index for veins (DV-PIV) and uterine artery pulsatility index (UtA-PI) and to evaluate the performance of screening with this model for all stillbirths and those due to impaired Placentation and unexplained causes. METHODS: This was a prospective screening study of 45 452 singleton pregnancies including 45 225 live births and 227 (0.49%) antepartum stillbirths; 131 (58%) were secondary to impaired Placentation and 96 (42%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to determine whether the addition of maternal serum PlGF improved the performance of screening that was achieved by a combination of maternal factors and PAPP-A, DV-PIV and UtA-PI. RESULTS: Significant contribution to the prediction of stillbirth was provided by maternal factor-derived a-priori risk and multiples of the median values of PlGF, DV-PIV and UtA-PI but not of serum PAPP-A. A model combining these variables predicted 42% of all stillbirths and 61% of those due to impaired Placentation, at a false-positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (71% vs 46%; P = 0.031). CONCLUSIONS: A high proportion of stillbirths due to impaired Placentation can be identified effectively in the first trimester of pregnancy. Addition of PlGF improves the performance of screening achieved by other maternal factors and biomarkers. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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placental growth factor in prediction of stillbirths at 11 13 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mirian Machuca, M Mendes, V Paschos, K H NicolaidesAbstract:Objectives To investigate whether measurement of maternal serum placental growth factor (PLGF) at 11-13 weeks’ gestation improves the performance of screening for stillbirths that is achieved by a combination of maternal factors and first trimester biomarkers such as maternal serum pregnancy associated plasma protein-A (PAPP-A), ductus venosus pulsatility index for veins (DV-PIV) and uterine artery pulsatility index (UT-PI) PI and to evaluate the performance of screening of this model for all stillbirths and those due to impaired Placentation and unexplained causes. Methods This was a prospective screening study of 45,452 singleton pregnancies including 45,225 live births and 227 (0.49%) antepartum stillbirths; 131 (58%) were secondary to impaired Placentation and 96 (42%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to determine whether the addition of maternal serum PLGF improved the performance of screening that was achieved by a combination of maternal factors and PAPP-A, DV-PIV and UT-PI. Results Significant contribution to the prediction of stillbirths was provided by maternal factor derived a priori risk and MoM values of PLGF, DV-PIV and UT-PI but not serum PAPP-A. A model combining these variables predicted 42% of all stillbirths and 61% of those due to impaired Placentation, at false positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth at <32 weeks’ gestation was higher than that of stillbirth at ≥37 weeks (71% vs 46%; p = 0.031). Conclusions The results of our study demonstrate that a high proportion of stillbirths due to impaired Placentation can be effectively identified in the first trimester of pregnancy. The extent to which such stillbirths could be prevented remains to be determined.
Ranjit Akolekar - One of the best experts on this subject based on the ideXlab platform.
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prediction of stillbirth from placental growth factor at 19 24 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: J E Aupont, Ranjit Akolekar, A Illian, S Neonakis, K H NicolaidesAbstract:Objectives To investigate whether the addition of maternal serum placental growth factor (PlGF) measured at 19–24 weeks' gestation improves the performance of screening for stillbirth that is achieved by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UtA-PI) and to evaluate the performance of screening with this model for all stillbirths and those due to impaired Placentation and unexplained or other causes. Methods This was a prospective screening study of 70 003 singleton pregnancies including 268 stillbirths, carried out in two phases. The first phase included prospective measurement of UtA-PI and fetal biometry, which were available in all cases. The second phase included prospective measurement of maternal serum PlGF, which was available for 9870 live births and 86 antepartum stillbirths. The values of PlGF obtained from this screening study were simulated in the remaining cases based on bivariate Gaussian distributions, defined by the mean and standard deviations. Multivariable logistic regression analysis was used to determine whether the addition of maternal serum PlGF improved the performance of screening that was achieved by a combination of maternal factors, fetal biometry and UtA-PI. Results Significant contribution to the prediction of stillbirth was provided by maternal factor-derived a-priori risk, multiples of the median values of PlGF, UtA-PI and fetal biometry Z-scores. A model combining these variables predicted 58% of all stillbirths and 84% of those due to impaired Placentation, at a false-positive rate of 10%. Within the impaired-Placentation group, the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (97% vs 61%; P < 0.01). Conclusions A high proportion of stillbirths due to impaired Placentation can be identified effectively in the second trimester of pregnancy using a combination of maternal factors, fetal biometry, uterine artery Doppler and maternal serum PlGF. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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prediction of stillbirth from maternal factors fetal biometry and uterine artery doppler at 19 24 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mayumi Tokunaka, Nelson Ortega, Argyro Syngelaki, K H NicolaidesAbstract:Objectives To evaluate the performance of screening for all stillbirths and those due to impaired Placentation and unexplained or other causes by a combination of maternal factors, fetal biometry and uterine artery pulsatility index (UT-PI) at 19–24 weeks’ gestation and compare this performance to that of screening by UT-PI alone. Methods This was a prospective screening study of 70,003 singleton pregnancies including 69,735 live births and 268 (0.38%) antepartum stillbirths; 159 (59%) were secondary to impaired Placentation and 109 (41%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to develop a model for prediction of stillbirth based on a combination of maternal factors, fetal biometry and UT-PI. Results Combined screening predicted 55% of all stillbirths, including 75% of those due to impaired Placentation and 23% of those that were due to other causes or unexplained, at false positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth at <32 weeks’ gestation was higher than that of stillbirth at ≥37 weeks (88% vs 46%; p < 0.001). The performance of screening by the combined test was superior to that of selecting the high-risk group on the basis of UT-PI being above the 90th percentile for gestational age, which predicted 48% of all stillbirths, 70% of those due to impaired Placentation and 15% of those that were due to other causes or unexplained. Conclusions Second-trimester screening by a combination of UT-PI with maternal factors and fetal biometry can predict a high proportion of stillbirths and in particular those due to impaired Placentation.
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prediction of stillbirth from placental growth factor at 11 13 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mirian Machuca, M Mendes, V Paschos, K H NicolaidesAbstract:OBJECTIVES: To investigate whether the addition of maternal serum placental growth factor (PlGF) measured at 11-13 weeks' gestation improves the performance of screening for stillbirths that is achieved by a combination of maternal factors and first-trimester biomarkers such as maternal serum pregnancy-associated plasma protein-A (PAPP-A), fetal ductus venosus pulsatility index for veins (DV-PIV) and uterine artery pulsatility index (UtA-PI) and to evaluate the performance of screening with this model for all stillbirths and those due to impaired Placentation and unexplained causes. METHODS: This was a prospective screening study of 45 452 singleton pregnancies including 45 225 live births and 227 (0.49%) antepartum stillbirths; 131 (58%) were secondary to impaired Placentation and 96 (42%) were due to other or unexplained causes. Multivariable logistic regression analysis was used to determine whether the addition of maternal serum PlGF improved the performance of screening that was achieved by a combination of maternal factors and PAPP-A, DV-PIV and UtA-PI. RESULTS: Significant contribution to the prediction of stillbirth was provided by maternal factor-derived a-priori risk and multiples of the median values of PlGF, DV-PIV and UtA-PI but not of serum PAPP-A. A model combining these variables predicted 42% of all stillbirths and 61% of those due to impaired Placentation, at a false-positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth < 32 weeks' gestation was higher than that of stillbirth ≥ 37 weeks (71% vs 46%; P = 0.031). CONCLUSIONS: A high proportion of stillbirths due to impaired Placentation can be identified effectively in the first trimester of pregnancy. Addition of PlGF improves the performance of screening achieved by other maternal factors and biomarkers. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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placental growth factor in prediction of stillbirths at 11 13 weeks
Ultrasound in Obstetrics & Gynecology, 2016Co-Authors: Ranjit Akolekar, Mirian Machuca, M Mendes, V Paschos, K H NicolaidesAbstract:Objectives To investigate whether measurement of maternal serum placental growth factor (PLGF) at 11-13 weeks’ gestation improves the performance of screening for stillbirths that is achieved by a combination of maternal factors and first trimester biomarkers such as maternal serum pregnancy associated plasma protein-A (PAPP-A), ductus venosus pulsatility index for veins (DV-PIV) and uterine artery pulsatility index (UT-PI) PI and to evaluate the performance of screening of this model for all stillbirths and those due to impaired Placentation and unexplained causes. Methods This was a prospective screening study of 45,452 singleton pregnancies including 45,225 live births and 227 (0.49%) antepartum stillbirths; 131 (58%) were secondary to impaired Placentation and 96 (42%) were due to other or unexplained causes. Multivariate logistic regression analysis was used to determine whether the addition of maternal serum PLGF improved the performance of screening that was achieved by a combination of maternal factors and PAPP-A, DV-PIV and UT-PI. Results Significant contribution to the prediction of stillbirths was provided by maternal factor derived a priori risk and MoM values of PLGF, DV-PIV and UT-PI but not serum PAPP-A. A model combining these variables predicted 42% of all stillbirths and 61% of those due to impaired Placentation, at false positive rate of 10%; within the impaired Placentation group the detection rate of stillbirth at <32 weeks’ gestation was higher than that of stillbirth at ≥37 weeks (71% vs 46%; p = 0.031). Conclusions The results of our study demonstrate that a high proportion of stillbirths due to impaired Placentation can be effectively identified in the first trimester of pregnancy. The extent to which such stillbirths could be prevented remains to be determined.
A Bhide - One of the best experts on this subject based on the ideXlab platform.
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prenatal identification of invasive Placentation using magnetic resonance imaging systematic review and meta analysis
Ultrasound in Obstetrics & Gynecology, 2014Co-Authors: F Dantonio, C Iacovella, Jose M Palaciosjaraquemada, C H Bruno, Lamberto Manzoli, A BhideAbstract:Objective To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnos- ing the presence, degree and topography of disorders of invasive Placentation and to explore the role of the differ- ent MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of inva- sive Placentation was also compared. and 'magnetic resonance imaging'. Only prospective studies reporting a diagnosis of invasive Placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacen- tal bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian-Laird random-effect or hierarchical summary receiver-operating characteristics models. Results A total of 18 studies involving 1010 pregnancies at risk for invasive Placentation were included. The over- all diagnostic accuracy of MRI in detecting the presence of invasive Placentation was: sensitivity, 94.4% (95% CI, 86.0-97.9%); specificity, 84.0% (95% CI, 76.0-89.8%); LR+, 5.91 (95% CI, 3.73-9.39); LR-, 0.07 (95% CI, 0.02-0.18); DOR, 89.0 (95% CI, 22.8-348.1). MRI had
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prenatal identification of invasive Placentation using ultrasound systematic review and meta analysis
Ultrasound in Obstetrics & Gynecology, 2013Co-Authors: F Dantonio, C Iacovella, A BhideAbstract:Objective The accuracy of prospective sonographic prenatal detection of invasive Placentation is unclear. The objective of this study was to conduct a systematic review and meta-analysis to assess the performance of ultrasound in at-risk women for prenatal identification of invasive Placentation. Methods MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE) and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched using the search terms ‘placenta accreta’, ‘placenta increta’, ‘placenta percreta’, ‘ultrasound’, ‘magnetic resonance imaging (MRI)’, ‘invasive placenta’ and ‘infiltrative placenta’. Two authors independently abstracted data from the articles. Sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR–), the diagnostic odds ratio (DOR) and their 95% CIs for each study were calculated. Forest plots and summary receiver–operating characteristics curves were produced. Between-study heterogeneity was explored both graphically and statistically. The MOOSE (meta-analysis of observational studies in epidemiology) guidelines were followed. Results Twenty-three studies involving 3707 pregnancies at risk for invasive Placentation were included. The overall performance of ultrasound for the antenatal detection of invasive Placentation was as follows: sensitivity, 90.72 (95% CI, 87.2–93.6)%; specificity, 96.94 (95% CI, 96.3–97.5)%; LR+, 11.01 (95% CI, 6.1–20.0); LR–, 0.16 (95% CI, 0.11–0.23); and DOR, 98.59 (95% CI, 48.8–199.0). Among the different ultrasound signs, color Doppler had the best predictive accuracy (sensitivity, 90.74 (95% CI, 85.2–94.7)%; specificity, 87.68 (95% CI, 84.6–90.4)%; LR+, 7.77 (95% CI, 3.3–18.4); LR–, 0.17 (95% CI, 0.10–0.29); and DOR, 69.02 (95% CI, 22.8–208.9)). Conclusions Ultrasound has a high accuracy for prenatal diagnosis of disorders of invasive Placentation in high-risk women. The use of color Doppler improves the test performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.
David N. Reznick - One of the best experts on this subject based on the ideXlab platform.
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why do placentas evolve a test of the life history facilitation hypothesis in two clades in the genus poeciliopsis representing two independent origins of placentas
Functional Ecology, 2014Co-Authors: Ronald D Bassar, Sonya K Auer, David N. ReznickAbstract:Summary Most of what we know about placentas comes from mammals, yet little can be learned from them about the adaptive significance of the placental mode of reproduction because they all derived their placenta from a single common ancestor that lived over 100 million years ago. We can make inferences about the adaptive significance of Placentation from fish in the family Poeciliidae because there have been multiple, recent origins of Placentation, affording an opportunity to compare close relatives with and without placentas and to seek properties that are common to each origin of Placentation. Here, we used field collections and a common garden study to quantify the degree of Placentation and related it to aspects of the life history in two clades of live-bearing fish from the genus Poeciliopsis that each contains an independent origin of Placentation. Doing so enables us to test the ‘life history facilitation hypothesis’, or the proposal that the placenta evolved to facilitate the evolution of some other feature of the life history. We found that the evolution of Placentation in each clade is tightly correlated with the evolution of other components of the life history, but that the nature of the association is radically different across the two clades. In the Northern Clade the magnitude of post-fertilization maternal provisioning is negatively correlated with age at maturity, mass at maturity, offspring dry mass and interlitter interval. In contrast, degree of matrotrophy in the Southern Clade is positively correlated with age at maturity, mass at maturity, offspring dry mass and inter-litter interval. There is thus no consistent relationship between the evolution of placentas and other features of the life history, which negates those proposals that the placenta evolved to facilitate the evolution of other features of the life history. However, there is a negative correlation between degree of Placentation and ovary dry mass and reproductive allocation common to both clades, suggesting that Placentation may be an adaptation that facilitates a reduction in reproductive allocation.
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why do placentas evolve an evaluation of the life history facilitation hypothesis in the fish genus poeciliopsis
Functional Ecology, 2011Co-Authors: Marcelo N. Pires, John U Regus, Ronald D Bassar, Kevin E Mcbride, Theodore Garland, David N. ReznickAbstract:Summary 1. The Northern Clade of the fish genus Poeciliopsis includes six closely related species, three of which lack placentas and three that have placentas but vary in the extent of post-fertilization provisioning. 2. We used this diversity to evaluate a series of hypotheses proposed in earlier publications concerning why the placenta has evolved. All hypotheses share the attribute of arguing that the placenta evolved to enhance the evolution of some other life-history trait, such as to reduce the age at maturation or to increase offspring size. We refer to these hypotheses collectively as ‘life-history facilitation hypotheses’. 3. A general way to evaluate the plausibility of such proposals is to ask whether the evolution of the placenta is predictably associated with the evolution of other components of the life history. 4. We evaluated such associations in two ways. First, we performed a multivariate analysis of life-history data for fish collected and preserved in nature. This analysis included 16 populations across all six species. Secondly, we performed a more complete quantification of the life histories of the laboratory descendents from five populations representing four species, then performed a similar multivariate analysis. The laboratory study added information about the timing of reproduction (age at maturity, frequency of reproduction). 5. Both analyses yielded similar results, which were that the evolution of increased Placentation is correlated with the evolution of a smaller size at first reproduction, the production of fewer and smaller offspring per litter, but an increase in the number of litters that were developing simultaneously in the ovary (superfetation). Increased Placentation is associated with progressively earlier ages at maturation and shorter intervals between the birth of successive litters of offspring. Overall, increased Placentation was associated with an increase in the rate of production of offspring early in life. A peculiar attribute of Placentation is that this increase in the rate of offspring production can be attained despite a simultaneous reduction in the proportional quantity of resources devoted to reproduction. 6. These trends support one of the life history facilitation hypotheses, which is that Placentation facilitates earlier maturity and a higher rate of reproduction early in life. They also suggest a possible connection between the evolution of the placenta and the well-established theory of life-history evolution, since these same life history attributes are predicted to evolve in response to exposure to high extrinsic rates of adult mortality.
F Dantonio - One of the best experts on this subject based on the ideXlab platform.
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prenatal identification of invasive Placentation using magnetic resonance imaging systematic review and meta analysis
Ultrasound in Obstetrics & Gynecology, 2014Co-Authors: F Dantonio, C Iacovella, Jose M Palaciosjaraquemada, C H Bruno, Lamberto Manzoli, A BhideAbstract:Objective To assess systematically the performance of prenatal magnetic resonance imaging (MRI) in diagnos- ing the presence, degree and topography of disorders of invasive Placentation and to explore the role of the differ- ent MRI signs in predicting these disorders. The diagnostic accuracy of ultrasound and MRI in the detection of inva- sive Placentation was also compared. and 'magnetic resonance imaging'. Only prospective studies reporting a diagnosis of invasive Placentation at the time of MRI and retrospective studies in which the radiologist was blinded to the final results were included in the analysis. The MRI signs explored were: uterine bulging, heterogeneous signal intensity, dark intraplacen- tal bands on T2 weighted sequences, focal interruption of the myometrium and tenting of the bladder. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios (LR+, LR-) and diagnostic odds ratio (DOR) were based, depending on the number of studies, upon DerSimonian-Laird random-effect or hierarchical summary receiver-operating characteristics models. Results A total of 18 studies involving 1010 pregnancies at risk for invasive Placentation were included. The over- all diagnostic accuracy of MRI in detecting the presence of invasive Placentation was: sensitivity, 94.4% (95% CI, 86.0-97.9%); specificity, 84.0% (95% CI, 76.0-89.8%); LR+, 5.91 (95% CI, 3.73-9.39); LR-, 0.07 (95% CI, 0.02-0.18); DOR, 89.0 (95% CI, 22.8-348.1). MRI had
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prenatal identification of invasive Placentation using ultrasound systematic review and meta analysis
Ultrasound in Obstetrics & Gynecology, 2013Co-Authors: F Dantonio, C Iacovella, A BhideAbstract:Objective The accuracy of prospective sonographic prenatal detection of invasive Placentation is unclear. The objective of this study was to conduct a systematic review and meta-analysis to assess the performance of ultrasound in at-risk women for prenatal identification of invasive Placentation. Methods MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE) and The Cochrane Central Register of Controlled Trials (CENTRAL) were searched using the search terms ‘placenta accreta’, ‘placenta increta’, ‘placenta percreta’, ‘ultrasound’, ‘magnetic resonance imaging (MRI)’, ‘invasive placenta’ and ‘infiltrative placenta’. Two authors independently abstracted data from the articles. Sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR–), the diagnostic odds ratio (DOR) and their 95% CIs for each study were calculated. Forest plots and summary receiver–operating characteristics curves were produced. Between-study heterogeneity was explored both graphically and statistically. The MOOSE (meta-analysis of observational studies in epidemiology) guidelines were followed. Results Twenty-three studies involving 3707 pregnancies at risk for invasive Placentation were included. The overall performance of ultrasound for the antenatal detection of invasive Placentation was as follows: sensitivity, 90.72 (95% CI, 87.2–93.6)%; specificity, 96.94 (95% CI, 96.3–97.5)%; LR+, 11.01 (95% CI, 6.1–20.0); LR–, 0.16 (95% CI, 0.11–0.23); and DOR, 98.59 (95% CI, 48.8–199.0). Among the different ultrasound signs, color Doppler had the best predictive accuracy (sensitivity, 90.74 (95% CI, 85.2–94.7)%; specificity, 87.68 (95% CI, 84.6–90.4)%; LR+, 7.77 (95% CI, 3.3–18.4); LR–, 0.17 (95% CI, 0.10–0.29); and DOR, 69.02 (95% CI, 22.8–208.9)). Conclusions Ultrasound has a high accuracy for prenatal diagnosis of disorders of invasive Placentation in high-risk women. The use of color Doppler improves the test performance. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.