Abstract
Placental adhesion disorder encompasses the various types of abnormal placentation that occur when the chorionic villi penetrate the uterine wall. Placenta accreta has become more common, mainly because of the increasing rates of cesarean section. Although ultrasound is the first-line imaging modality for evaluation of the placenta, it plays a limited role in cases of posterior placenta accreta and inconclusive findings. In such cases, magnetic resonance imaging (MRI) is indicated, mainly because it is a more accurate means of identifying placental invasion of extrauterine structures in high-risk pregnant women. In this review article, we present the ten major and minor MRI features of placental adhesion disorder, as described in the international literature. In addition, we propose a template for structured reports of MRI examinations of the placenta. We have also devised a guided questionnaire in order to identify risk factors in patients scheduled to undergo such examinations, with the objective of facilitating the multidisciplinary treatment planning needed in order to minimize maternal morbidity and mortality.
Highlights
Placental adhesion disorder (PAD), commonly known as placenta accreta, is a group of disorders resulting from a deficiency in the decidua basalis that causes the chorionic villi to penetrate the myometrium(1)
The major risk factors for placenta accreta are a previous cesarean section and placenta previa, less common risk factors including a history of conservative myomectomy, uterine artery embolization, curettage, or uterine rupture(1), as well as advanced maternal age(5)
Research shows that the incidence of placenta accreta in the general population is approximately 0.9%, that rate increases to 9% when there is concomitant placenta previa and can be as high as 35% when there is a combined history of placenta previa and cesarean section(6)
Summary
Placental adhesion disorder (PAD), commonly known as placenta accreta, is a group of disorders resulting from a deficiency in the decidua basalis that causes the chorionic villi to penetrate the myometrium(1). These disorders are classified according to the depth of uterine invasion by the trophoblastic tissue(2,3). In patients who have undergone more than three cesarean sections, the risk of invasive placenta has been reported to be 67%(5). We propose a template for a structured report encompassing all of those features, as well as a questionnaire about the possible risk factors in patients who will undergo an MRI examination of the placenta
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