COULD AN ONLINE ULTRASOUND TRAINING PROGRAMME IMPROVE THE ACCURACY AND TIMELINESS OF DIAGNOSIS OF PLACENTA ACCRETA SPECTRUM DISORDER?
By Isabelle Dowle, University of Sheffield
Objective:
In placenta accreta spectrum disorder (PAS), the placenta embeds abnormally into the uterine wall because of unregulated trophoblast invasion. It can cause premature birth and maternal mortality due to haemorrhage. Furthermore, rates of PAS are increasing in concordance with increasing rates of caesarean sections. Ultrasound is the first-line imaging modality for diagnosing PAS, but many sonographers lack sufficient exposure to abnormal placental implantation to confidently identify the signs, and up to two-thirds of cases are thought to be undiagnosed prior to delivery. This research aimed to both explore whether providing online training can improve sonographers’ confidence and accuracy in identifying PAS, and whether identification before 28 weeks of gestation is feasible.
Methods:
An online training tool, comprising three sections was compiled, using both normal and pathological ultrasound images. Images from histologically confirmed PAS patients (n=5) were checked for their ultrasound signs, reviewed by 2 experts, and subdivided into 3 gestational groups. Expert and non-expert PAS individuals, including sonographers were recruited. For cases where the participants answered that the placenta was ‘abnormal’, they indicated which ultrasound signs they thought were present, and their confidence in their answer before (part 1), and after (part 3) accessing an interventional educational resource (part 2).
Results:
9 participants completed pre-training, and 7 post-training. There was a statistically significant increase in test scores after training (P<0.05), but not in their confidence levels. More participants correctly identified lacunae, loss of clear zone and Colour Doppler abnormalities after training, and >50% of participants correctly identified the cases being normal/abnormal at 10-16 and 18-22 weeks. Bladder wall abnormalities however were poorly identified.
Conclusions:
Providing a training programme on identifying specific ultrasound signs in PAS could provide earlier and more accurate identification of PAS. A bigger sample and further re-testing to improve confidence levels could deliver more definitive conclusions.