Contrast enhanced ultrasound (CEUS) in the prenatal evaluation of suspected invasive placenta percreta

Abstract

Morbidly adherent placentation now complicates approximately 1 in 500 pregnancies. Our group and others have demonstrated that antenatal diagnosis of invasive placentation and team-based delivery reduce severe morbidity. Ultrasound and magnetic resonance imaging (MRI) are both employed in the antenatal evaluation of pregnancies with suspected placenta increta/percreta. Accurate diagnosis in this context is essential to direct resources appropriately. Ultrasound methods, including colour and power Doppler, are the mainstays of screening at-risk women, whereas MRI is reserved for diagnostic purposes because of its cost and limited accessibility. In current practice, both methods are significantly limited by an inability to accurately define aberrant utero-placental blood flow, the definitive sign of deeply invasive placentation. We describe here an adjunctive method to define aberrant blood flow using ultrasound. We employed contrast-enhanced ultrasound (CEUS) in the antenatal evaluation of suspected extensive invasive placentation in a woman at 18 weeks' gestation. Invasive placentation was confirmed following hysterectomy. CEUS, a technique that has been established as safe and well tolerated in the non-pregnant setting, has the potential to be deployed as a powerful adjunct to ultrasound to enhance both the screening and diagnostic components of care for women with suspected invasive placentation.