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Objective: To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second‐ and third‐trimester ultrasound examination in pregnancies at risk for PAS. Methods: PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case–control or cross‐sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios. Results: A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta‐analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78–92%) and specificity of 63% (95% CI, 55–70%) during the first trimester, and a sensitivity of 88% (95% CI, 84–91%) and specificity of 92% (95% CI, 85–96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19–100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96–100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72–86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97–100%)). Conclusions: First‐trimester ultrasound examination has similar accuracy to second‐ and third‐trimester ultrasound examinations for the diagnosis of PAS. Routine first‐trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background and Aim: Preterm birth (PTB) accompanies with morbidities and mortality among newborns. This study aimed to show that different factors such as economic (adjusted net national income and gross domestic product [GDP] per capita), human developmental (human developmental index), and health (overall health performance, pregnancy prenatal care rate, and modeled estimated maternal mortality rate) indexes might influence the prevalence of PTB. Methods: To this, the top 10 countries with the highest and lowest prevalence of PTB were extracted from the Global Burden of Disease report for PTB. Then, we have gathered some common indexes for economic (adjusted net national income and GDP per capita), health‐related (overall health performance, pregnancy prenatal care rate, and modeled estimated maternal mortality rate), and combined developmental (human developmental index) factors from different resources including World Bank and United Nations for those countries. The truncated Bayesian linear regression model, decision tree, and k‐means clustering algorithms were used for data analysis. Results: The results showed Pregnancy Prenatal Care Rate index has a significant effect on the PTB rate in the top 10 countries with the highest prevalence of PTB. Also, for the top 10 less prevalent countries for PTB, it was shown that modeled estimated maternal mortality rate, human developmental index rank, and pregnancy prenatal care rate have significant effects on PTB rate. In addition, the clustering based on the similarities in socioeconomic, human developmental, and health indexes were approximately like with the clustering of the countries based on the PTB rates (Rand index = 0.823). Conclusion: The results showed studies on the epidemiology of PTB (either worldwide or nation‐based) should consider these confounder factors to obtain accurate results. [ABSTRACT FROM AUTHOR]