MRI Distinguish the Types of Placental Accrete Ability and Finding: 27 Patients Results

Tianran Li,Xiaobin Huang,Fayu Chen,Beibei Zhang,Zhijie Yang

doi:10.11648/j.jgo.20190705.12

Abstract

The placenta accrete is a kind of emergency and it leads to maternal postpartum hemorrhage, and one of the causes of death. Its aims is to evaluate diagnostic ability and findings of MRI in placental accrete of different types. This study included 27 pregnant women who were all histologically confirmed placental accrete after operation. According to the Maldjia diagnostic MRI criteria. The sensitivity and accuracy of MRI imaging were compared, and the MRI features of placental accrete were also described. The results showed a statistically significant difference among the three radiologists in MRI classification (P 0.05), chi square test (c2) showed no difference between the two types diagnostic capabilities (P>0.05). ADC and high b value DWI both showed slightly high signal of placental accrete. Residual placenta demonstrated flower braid or mushroom inhomogeneous enhancement. Comparison of MRI and US, 0 and 1 type are no obviously difference between US and MRI (P>0.05), but there are statistical difference (P<0.05) for distinguishing type 2 and type 3. MRI has a high diagnostic accuracy in placental implantation and the location, extent and depth of its invasion, displaying the condition of blood supply, and the drawing the typing diagnosis based on them. Moreover, MRI was more useful than US in distinguishing type 2 and type 3 of placental accrete.

Highlights

Placental implantation abnormalities (PIAs) are kinds of disorder of the placenta dysplastic disease, including low placenta and marginal placenta, placenta previa, placenta accrete, vasa previa, and velamentous cord insertion
The Placenta accrete is due to uterine decidua dysplasia, and in order to obtain blood supply, chorionic villi tissues invade into myometrium from decidua basalis with developmental defects, even though penetrating muscularis deepth into serosa and abdominal cavity [2]
The placenta accrete is a kind of emergency and it leads to maternal postpartum hemorrhage, and one of the causes of death, because the placenta accrete run into muscular layer depth and the fatality rate is related to postpartum hemorrhage [3]

Summary

Introduction

Placental implantation abnormalities (PIAs) are kinds of disorder of the placenta dysplastic disease, including low placenta and marginal placenta, placenta previa, placenta accrete, vasa previa, and velamentous cord insertion. According to a meta-analysis in the PIAs, Low placenta and marginal placenta are 26.9%, placenta previa 43.5%, placenta accrete 57.7%, vasa previa 81.9%, and velamentous cord insertion 37.5% [1]. Along with the increase in cesarean section, abortion and maternal aging, more and more the placenta accrete is found in clinical works. Ultrasound (US) can provide an accurate diagnosis of PIAs, US has been reported to have a sensitivity of 91% and a specificity of 97% for the diagnosis of morbidly adherent placenta in a recent meta-analysis [4].

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