Antenatal Diagnosis Of Placenta Accreta Research Articles

Frequency of Placenta Previa – Placenta Accreta in Patients with Previous Cesarean Section

Abstract Objective: To study the frequency of placenta previa/ accreta in patients with previous cesarean section. Study Design: Prospective hospital based study. Place and Duration of Study: Gyne unit 2 Nishtar Hospital Multan from November 2010 to September 2011. Patients and Methods: The study included patients admitted with the suspicion of placenta previa through the out patient department in the ward and in the labor room as emergency cases with antepartum hemor-rhage. Diagnosis was confirmed by transabdominal ultrasound and in patients with anterior placenta previa and previous cesarean section, doppler ultrasound was requested to diagnose placenta accreta. Detailed his-tory, clinical examination and baseline investigation was done in all patients. Results: During the study period 38 cases of major degree placenta previa were managed. 22 (57.89%) were emergency admissions and 16 (42.10%) were admitted throughout patient department. 29 (76.39%) patients had previous cesarean section and 9 (23.68%) patients had all previous vaginal deliveries. 8 (27.58%) patients had previous one cesarean section and 21 (72.41%) had 2 or more cesarean sections, 4 (10.52%) patients had placenta accreta and out of these 3 pati-ents were diagnosed antenatally by doppler ultrasound and one patient was diagnosed at emergency cesarean section. Conclusion: The major risk factor for the placenta previa is uterine scaring and therefore the incidence is increasing with increasing cesarean section rate. Pla-centa accreta is one of the most serious complications of placenta previa. It is suggested that in patients with anterior major degree placenta previa and previous cesarean section, antenatal diagnosis of placenta acc-reta should be made by doppler ultrasound so that appropriate management plan can be made. Keywords: Placenta previa, placenta accreta, cesa-rean section.

P30.04: The role of ultrasonography and color Doppler imaging in antenatal diagnosis of placenta accreta in high‐risk patients

P30.04: The role of ultrasonography and color Doppler imaging in antenatal diagnosis of placenta accreta in high‐risk patients

Role of three‐dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray‐scale and color Doppler techniques

To assess the role of three-dimensional (3D) power Doppler in the antenatal diagnosis of placenta accreta and compare its diagnostic performance with gray-scale and color Doppler ultrasonography. One hundred and seventy pregnant women with persistent placenta previa totalis (after 28 weeks' gestation) were prospectively enrolled into this study. Gray-scale transabdominal ultrasound examination was performed to detect loss of the subendometrial echolucent zone and other abnormalities suggestive of placenta accreta. Color flow mapping was used to scan the whole placenta to detect any newly formed vessels at the serosa-bladder border or the presence of abnormal lacunae. Finally a targeted examination of angioarchitecture in the basal and lateral views of the placenta was carried out using 3D power Doppler. The ultrasound findings were analyzed with reference to the final diagnosis made during Cesarean delivery. Placenta accreta and its variants (including increta and percreta) were confirmed in 39 patients at the time of Cesarean delivery. Based on receiver-operating characteristics analysis, 'numerous coherent vessels' visualized using 3D power Doppler in the basal view was the best single criterion for the diagnosis of placenta accreta, with a sensitivity of 97% and a specificity of 92%. If we considered the presence of at least one criterion to be diagnostic when using each ultrasound technique, then 3D power Doppler would have the best positive predictive value (76%), followed by gray-scale (51%) and color Doppler (47%). The majority of patients with placenta accreta showed multiple characteristic features on ultrasound imaging. In contrast, those patients with a false-positive diagnosis (i.e. the final diagnosis was placenta previa alone) tended to show isolated ultrasound markers of the condition. 3D power Doppler may be useful as a complementary technique for the antenatal diagnosis or exclusion of placenta accreta.

OC277: A comparison of sonographic criteria for antenatal diagnosis of placenta accreta

OC277: A comparison of sonographic criteria for antenatal diagnosis of placenta accreta

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

Antenatal diagnosis of non‐previa placenta increta with histological confirmation

The antenatal diagnosis of placenta accreta

The antenatal diagnosis of placenta accreta is invaluable in planning an approach to delivery or to management of an early intrauterine demise. The women most at risk are those who have had uterine surgery and have placenta previa, but placenta accreta can occur in any pregnancy. In early pregnancy the most useful ultrasound finding is implantation of the sac over a uterine scar. Vascular sinuses, appearing as early as 15 weeks, are irregularly shaped, have obvious blood flow when evaluated with color Doppler, and have the highest sensitivity for placenta accreta. Loss of the usual retroplacental clear space as a sole finding will usually be false positive. Magnetic resonance imaging diagnosis is in its infancy and has not yet been proven to add information unless the placenta is posterior. In the future it will hopefully aid in distinguishing placenta accreta from percreta.

The antenatal diagnosis of placenta accreta

The antenatal diagnosis of placenta accreta is invaluable in planning an approach to delivery or to management of an early intrauterine demise. The women most at risk are those who have had uterine surgery and have placenta previa, but placenta accreta can occur in any pregnancy. In early pregnancy the most useful ultrasound finding is implantation of the sac over a uterine scar. Vascular sinuses, appearing as early as 15 weeks, are irregularly shaped, have obvious blood flow when evaluated with color Doppler, and have the highest sensitivity for placenta accreta. Loss of the usual retroplacental clear space as a sole finding will usually be false positive. Magnetic resonance imaging diagnosis is in its infancy and has not yet been proven to add information unless the placenta is posterior. In the future it will hopefully aid in distinguishing placenta accreta from percreta.

P282: Antenatal diagnosis of placenta accreta with Color Doppler and magnetic resonance imaging

P282: Antenatal diagnosis of placenta accreta with Color Doppler and magnetic resonance imaging

Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta.

To determine whether magnetic resonance imaging (MRI) and ultrasound (US) are effective methods for diagnosing placenta accreta, increta, or percreta antenatally. We retrospectively reviewed radiologic reports of patients who had the diagnosis of placenta accreta, percreta, or increta by pathologic analysis. The gestational age at first ultrasound diagnosis of accreta and first MRI diagnosis of accreta was recorded. Ultrasound and MRI reports were examined for findings of a distorted retroplacental myometrial zone, disrupted uterine-bladder interface, focal exophytic masses, and presence of vascular placental lacunae. Surgical history, cesarean hysterectomy, and blood loss were also recorded. Thirteen patients were identified, and 14 had true pathologic confirmation of accreta, increta, or percreta. Nine of thirteen had MRI, and of those, seven received gadolinium. Placenta accreta was diagnosed by MRI in five of nine patients, but only four were confirmed pathologically to have accreta. Four women who had a normal MRI had accreta confirmed by pathology (sensitivity 38%). Of the 13 patients who had US, four were considered to have an accreta, and these four had pathologic confirmation. Nine were negative for accreta by US; however, eight of those women had pathologic confirmation of accreta, and one was normal (sensitivity 33%). Both MRI and US had poor predictive value in the diagnosis of placenta accreta, and further refinement in the techniques of both MRI and US is needed for these tests to be used to reliably diagnose these pathologic conditions.

Placenta Accreta—Summary of 10 Years: A Survey of 310 Cases

The objective was to study the incidence, risk factors, and outcome of pregnancies complicated by placenta accreta in our population. Retrospective analysis of all deliveries between the years 1990–2000, and identification of all cases of placenta accreta, defined by clinical or histological criteria. For comparison purposes we defined two sub-groups: (i) all cases that ended with severe outcome and (ii) all patients who had a previous event of placenta accreta in one or more of their previous deliveries. We evaluated the potential risk factors leading to these conditions. The SPSS software package was used for statistical analysis. Univariate and multivariate analyses were performed by stepwise logistic regression. The study covered 34450 deliveries from which 310 cases of placenta accreta were diagnosed (0.9 per cent). The risk factors associated with placenta accreta were previous cesarean delivery (12 per cent), advanced maternal age, high gravidity, multiparity, previous curettage and placenta previa (10 per cent). Hysterectomy was performed in 11 patients (3.5 per cent) with one case of maternal death, whereas 21 per cent of the patients required postpartum blood products transfusion. Antenatal diagnosis of placenta accreta or percreta by ultrasound or MRI, was achieved only in eight of the cases. In the sub-group of 15 patients (4.8 per cent) with severe outcome, the only significant risk factors were increased parity (O.R.=1.29, 95 per cent CI 1.056–1.585), anteriorly low placenta (O.R.=6.1, 95 per cent CI 1.4–25.3) and repeated cases of caesarean sections (O.R.=3.3, 95 per cent CI 0.9–12.5), whereas in the 49 (16 per cent) patients with repeated cases of placenta accreta the only significant risk factor was the number of deliveries (O.R.=1.5, 95 per cent CI 1.0–2.2). Repeated cesarean delivery, high parity, and anteriorly low placental location are associated with severe outcome in case of placenta accreta. Women with repeated events of placenta accreta may have better outcome and a genetic factor may serve as a cause for this condition.

Use of Magnetic Resonance Imaging and Ultrasound in the Antenatal Diagnosis of Placenta Accreta

Use of Magnetic Resonance Imaging and Ultrasound in the Antenatal Diagnosis of Placenta Accreta

High temporal resolution dynamic contrast MRI in a high risk group for placenta accreta

Antenatal diagnosis of placenta accreta with MR is not easy even now because T 2-weighted images (T2WI) cannot differentiate chorionic villi from decidua basalis. We performed dynamic contrast MRI to study whether trophoblastic villi could be separately demonstrated from the decidua basalis, and whether the contrast resolution between the placenta and myometrium could improve compared to T2WI. Six pregnant women with prior cesarean section were examined at 34–38 gestational weeks. Sagittal T 2-weighted images with fast spin echo sequences and dynamic contrast studies with fast field echo sequence every 10–14 s after contrast injection were performed. We analyzed the enhancing pattern of the placenta and compared the contrast between placenta and myometrium. We reviewed medical records to identify complications during the placental delivery and the complications of their newborns. In the early phase after contrast enhancement, multiple foci of the strong lobular enhancement were observed in all cases. Other parts of placenta were slowly but strongly enhanced following them. We speculated that the former corresponded to intervillous space and the latter decidua basalis. The contrast between placenta and myometrium tended to be distinct near the inner cervical os on both T2WI and dynamic contrast study. On the other hand, it was indistinct in the upper part of the uterine body on T2WI despite it was clearly demonstrated on dynamic contrast study. The placentae were delivered without any complication in all cases. Although two neonates showed fetal distress, none of the infant remained any sequelae at the time of the discharge. The other four were well although one of them complicated with meconium staining. As dynamic contrast MRI can differentiate chorionic villi and decidua basalis, and can provide excellent contrast between placenta and myometrium at anywhere within the uterus, it may be a promising technique for antepartum diagnosis of the placenta accreta.

Placenta accreta

Total placenta accreta is a rare condition. Its management is a dilemma. Attempted separation of the placenta in placenta accreta can cause torrential blood loss. Therefore an antenatal diagnosis of placenta accreta permits advance planning of delivery. Two alternatives are caesarean section through the fundus with subsequent immediate hysterectomy, which has traditionally been the treatment of choice or if the patient wishes more children, leaving the placenta in place and managing conservatively. We present a 38 year old lady who was diagnosed to have placenta accreta while performing a caesarean section for a breech presentation. We had to proceed with a total hysterectomy.