Diagnosis Of Placenta Accreta Research Articles

Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study.

The objective of this study is to investigate the value of early pregnancy ultrasound combined with ultrasound score (USS) for the evaluation of placenta accreta (PA) in scar uteri. Thirty cases of PA in scar uteri diagnosed by ultrasound at our hospital between June 2021 and June 2022 were selected retrospectively (observation group). In addition, 30 patients had placenta attached to the anterior wall of the uterus and covered the internal orifice of the cervix; however, no PA was selected in the same period (control group). The results of surgical pathology and ultrasound examination in the first trimester of pregnancy (11-14 weeks of pregnancy, fetal top hip length 4.5-8.4 cm) were analyzed. Ultrasonic image characteristics of the 2 groups were scored using an ultrasonic scoring scale. The ultrasonic signs and ultrasonic scores of the 2 groups were analyzed. The diagnostic value of ultrasound and USS for PA in the scarred uterus alone and in combination was analyzed based on the gold standard of surgical and pathological results. The rich blood flow signal at the junction of the uterine serosa and bladder, the rate of blood flow in the cavity of the placental parenchyma, the thinning rate of the myometrium after placenta, and the abnormal rate of the low echo area after placenta in the observation group were significantly higher than those in the control group (P < .05). The USS of the observation group was significantly higher than that of the control group (P < .05). The sensitivity (93.33%) and accuracy (95.00%) of the combined examinations were significantly higher than those of ultrasound (70.00% and 83.33%, respectively) (P < .05). The sensitivity and accuracy of combined examination were slightly higher than those of USS examination (83.33% and 90.00%), but the difference was not statistically significant (P > .05). There was no significant difference between the specificity of combined examination (93.33%) and ultrasound (96.67%) and USS (96.67%) (P > .05). Early pregnancy ultrasound and USS evaluation have high application value in the diagnosis and evaluation of early scar uterine PA. The combination of the 2 methods can further improve the sensitivity and accuracy of diagnosis.

Placenta Invasion Anomaly without Placenta Previa in the First Trimester of Pregnancy and its Conservative Management: A Case Presentation.

Diagnosing placenta accreta spectrum (PAS) is rather difficult in the first trimester of pregnancy. Especially if the localization of the placenta is not in and around the cervical canal, this may not attract the attention of obstetricians. Early diagnosis can decrease bleeding during curettage or miscarriage, but there are no guidelines regarding its diagnosis in the first trimester. In addition, there is insufficient evidence-based knowledge in the literature on the management and treatment of PAS without placenta previa. In this article, conservative treatment without hysterectomy of a patient diagnosed with PAS in first trimester was presented.

Comparing the Efficacy of Two-Dimensional Ultrasound and Three-Dimensional Power Doppler for Diagnosing Placenta Accreta Spectrum Disorders and Predicting Complications: A Prospective Cross-Sectional Study.

Comparing the Efficacy of Two-Dimensional Ultrasound and Three-Dimensional Power Doppler for Diagnosing Placenta Accreta Spectrum Disorders and Predicting Complications: A Prospective Cross-Sectional Study.

838 Transvaginal/Transvesical Ultrasound (TVUS) to Diagnose Placenta Accreta Spectrum (PAS), its Severity & to Predict Blood Loss

838 Transvaginal/Transvesical Ultrasound (TVUS) to Diagnose Placenta Accreta Spectrum (PAS), its Severity & to Predict Blood Loss

Placenta accreta on non-scarred uterus: About a case

Placenta accreta is an abnormally adherent placenta (abnormal adhesion of the placenta to the myometrium), due to the localized or diffuse absence of the decidua basalis. Its incidence increases with increasing cesarean section rates. Placenta accreta in a non-scarred uterus is very rare but remains possible due to other risk factors which are age, smoking, placenta preavia and finally invasive endouterine procedures. Among its consequences, we first note the hemorrhage of delivery which can be associated with significant maternal morbidity and mortality, uterine rupture and also the invasion of adjacent organs by the placental trophoblast. We report an interesting case of placenta accreta on a non-scarred uterus discovered during a planned cesarean section for placenta previa. This is a 41-year-old patient with no history of scarred uterus, 5th procedure, 3rd parity, with history of spontaneous miscarriage cured at 2 months, pregnant at 39 weeks, unmonitored pregnancy, admitted to the maternity emergency room for two days before for delivery method where the parturient benefited from a clinical examination and an obstetric ultrasound showing a completely covering anterior placenta, amniotic fluid of normal quantity and an estimate of the fetal weight at 2800g, then scheduled for a cesarean section. The diagnosis of placenta accreta is made during cesarean section. We opted for radical treatment. Placenta accreta is a pathology at risk of serious hemorrhagic complications during pregnancy and the postpartum period. This should encourage us to systematically search for ultrasound criteria for placenta accreta. The ultrasound report, in these patients, must explicitly mention this. Adequate care in the presence of a multidisciplinary team makes it possible to limit the mortality and morbidity associated with this pathology.

OC08.05: Apparent diffusion coefficient histogram analysis and ultrasound in diagnosing placenta accreta spectrum disorders and predicting postpartum bleeding

OC08.05: Apparent diffusion coefficient histogram analysis and ultrasound in diagnosing placenta accreta spectrum disorders and predicting postpartum bleeding

Impact of planned versus emergency cesarean delivery on neonatal outcomes in pregnancies complicated by abnormal placentation: A systematic review and meta-analysis.

Although planned cesarean delivery (PCD) is the mainstay of management for abnormal placentation, some patients still require emergency cesarean delivery (ECD). We aimed to systematically analyze the impact of various modes of delivery on neonatal outcomes. This study was complied with the PRISMA guidelines and was registered in the PROSPERO (code: CRD42022379487). A systematic search was conducted on Ovid MEDLINE and Embase, Web of Science, PubMed, and the Cochrane databases. Data extracted included gestational age at delivery, birth weight, the Apgar scores at 1 and 5 minutes, numbers of newborns with low Apgar score (<7) at 5 minutes, the rates of neonatal intensive care unit admission, and the rates of neonatal mortality. Fifteen cohort studies met the inclusion criteria, comprising a total of 2565 women (2567 neonates) who underwent PCD (n = 1483) or ECD (n = 1082) for prenatally diagnosed placenta accreta spectrum (PAS) and/or placenta previa (PP). Compared with the ECD group, neonates in the PCD group had significantly higher gestational ages (standardized mean difference [SMD]: 2.20; 95% confidence interval [CI]: 1.25-3.15; P < .001), birth weights (SMD: 1.64; 95% CI: 1.00-2.27; P < .001), and Apgar scores at 1 minute (SMD: 0.51; 95% CI: 0.29-0.73; P < .001) and 5 minutes (SMD: 0.47; 95% CI: 0.25-0.70; P < .001). Additionally, the PCD group had significantly lower rates of neonatal intensive care unit admission (odds ratio [OR]: 0.21; 95% CI: 0.14-0.29; P < .001), low Apgar score at 5 minutes (OR: 0.27; 95% CI: 0.11-0.69; P = .01), and neonatal mortality (OR: 0.13; 95% CI: 0.05-0.33; P < .001). When pregnancies are complicated by abnormal placentation, PCD is linked to noticeably better neonatal outcomes than emergent delivery.

Role of magnetic resonance imaging in the diagnosis of placenta accreta.

To analyze the value of magnetic resonance imaging (MRI) in suspicious cases for prenatal detection of placenta accreta (PA). A total of 50 placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus.HASTE(half-Fourier acquisition single-shot turbo spin echo)and True-FISP (true fast imaging with steady-state precession) sequences were acquired. Findings from MRI were compared with the final diagnosis, which was determined by clinical findings at delivery and pathological examination of specimens. Of 50 pregnant women in the analysis, 33 required cesarean hysterectomy, and 17 underwent cesarean delivery.MRI signs such as myometrial thinning, loss of T2 hypointense interface(loss of retroplacental clear space on US), heterogenous intraplacental sign, and intraplacental T2 dark bands were more likely to be seen in this group. In this group, the cases that were finally clinically and pathologically confirmed were 12, 16, and 22 cases of placenta accreta vera, placenta increta, and placenta percreta respectively. MRI is particularly useful in cases where US is inconclusive and to assess the extent to which the placenta penetrates the uterine serosa and invades outward into surrounding tissues.MRI has become a routine examination for patients with suspected PA in clinical practice.

Management strategy for urologic morbidity in surgery of placenta accreta spectrum: stents or catheters?

Objective Surgery for placenta accreta spectrum disorders is known to be associated with urologic morbidity. Although previous studies have shown preoperative ureteral stent placement might be useful for preventing the urologic morbidity, the patient’s discomfort caused by it should not be ignored. Whether there is an alternative management strategy remains unknown. This study was to evaluate the effectiveness of ureteral stents and catheters in preventing urologic injury in patients with placenta accreta spectrum undergoing surgery. Methods We conducted a retrospective cohort study. All cases with diagnosed placenta accreta spectrum who underwent surgery at Peking University Third Hospital between January 2018 and December 2020 were collected and reviewed. They were divided into two groups according to the different management strategies for preoperative placement of ureteral catheters or stents. The primary outcome was urologic injury, which was defined as the presence of ureteral or bladder injury during and after surgery. Secondary outcomes included urologic complications within the first three months after surgery. The median (interquartile range) or proportions were reported for variables. The Man Whitney U test, chi-square test and multivariate logistic regression were used for analysis. Results Ultimately, 99 patients were included in this study. Ureteral catheters were placed in 52 patients and ureteral stents were placed in 47 patients. Placenta accreta, placenta increta, and placenta percreta were diagnosed in three, 19, and 77 women, respectively. The hysterectomy rate was 52.53%. Overall, urologic injuries occurred in three patients (3.03%), including one case of combined bladder and ureteral injury (1.01%) and two cases of bladder injuries (2.02%). Only one ureteral injury occurred in a patient with a ureteral stent, which was recognized postoperatively (p = .475). All bladder injuries were vesical rupture which were recognized and repaired intraoperatively; one patient in the catheter group and two patients in the stent group (p = .929). After adjusting for confounding variables, multinomial regression analysis revealed no significant differences between the two groups in the incidence of bladder injuries(aOR: 0.695, 95% CI: 0.035–13.794, p = .811). A lower risk of urinary irritation (aOR: 0.186, 95% CI: 0.057–0.605, p = .005), hematuria (aOR: 0.011, 95% CI: 0.001–0.136, p < .001), and lower back pain (aOR: 0.075, 95% CI: 0.022–0.261, p < .001) was found in patients with ureteral catheters than in those with ureteral stents. Conclusion The ureteral stents didn’t confer a protective benefit in the surgical management for placenta accreta spectrum compare with catheters; however, they did result in a higher incidence of postoperative urologic complications. Ureteral temporal catheters may be an alternative strategy for placenta accreta spectrum cases suspected with urinary tract involved prenatally. Moreover, clearly and explicitly reporting “double J stent” or “temporal catheter” is necessary for future researches.

The Value of MRI in the Diagnosis of Placenta Previa

Objective To analyze the diagnostic value of MRI in placenta previa. Methods 100 pregnant women with placenta previa admitted to our hospital from January 2017 to January 2020 were selected as the research objects. They were randomly divided into groups by digital table. Group A (50 cases) carried out magnetic resonance imaging (MRI) examination, and Group B (50 cases) carried out Doppler ultrasound examination. The detection of disease types and diagnostic accuracy were compared, and the imaging manifestations of MRI in the diagnosis of placenta accreta and non placenta accreta were analyzed. Results The detection rate of central type, marginal type and partial type in group A was higher than that in group B (P < 0.05). With surgery and pathology as the gold standard, the diagnostic accuracy and sensitivity of group A were higher than that of group B, and the rate of missed diagnosis was lower than that of group B (P < 0.05). Among the 50 pregnant women in Group A, 9 had placenta implantation and 41 had no placenta implantation. There were differences in the imaging manifestations of the pregnant women, such as the uneven signal in the placenta, the increased/thickened blood vessels in the placenta, and the unclear boundary between the placenta and the uterus (P < 0.05). Conclusion MRI examination is an important way for clinical diagnosis of placenta previa, and it is worth popularizing.

Effective training program for antenatal diagnosis of placenta accreta spectrum disorder.

To develop and evaluate a training program for diagnosing placenta accreta spectrum (PAS) disorder in obstetrics/gynecology and radiology residents. This single-center prospective study was based on 177 ultrasound images of pathologically confirmed PAS extracted from 534 cases of placenta previa suspicious for PAS. First- to third-year residents were evaluated before training to assess experience and ability to diagnose PAS. They attended a principal lecture followed by weekly self-study exercises over 5 weeks. Post-course tests evaluated the efficacy of the training program for improving diagnosis of PAS after the program. Twenty-three (38.3%) obstetrics/gynecology and 37 (61.7%) radiology residents were trained. Before the training program, 98.3% reported minimal experience and 100% low confidence to correctly diagnose PAS. During the program, the overall accuracy of all participants in diagnosing PAS increased from 71.3% before to 95.2% after training (P < 0.001). Regression analyses showed that ability to diagnose PAS increased 2.52-fold (P < 0.001) following the program. The retention of knowledge at 1, 3, and 6 months posttest was 84.7%, 87.5%, and 87.7%, respectively. An antenatal diagnosis of PAS training program can be effective as a residency training program, considering the globally rising cesarean delivery rates.

Unsuspected placenta accreta spectrum at vaginal delivery: assessment of incidence, characteristics, and maternal morbidity

Placenta accreta spectrum refers to morbidly adherent trophoblastic tissue invading into the gravid uterus and is associated with significant maternal morbidity. Most cases of placenta accreta spectrum are suspected antenatally, and most patients undergo planned, late-preterm cesarean hysterectomy to reduce the risk of morbidity. Rarely, however, placenta accreta spectrum is incidentally diagnosed at vaginal delivery, but there is a scarcity of data regarding these events. This study aimed to examine the incidence, characteristics, and outcomes of pregnant individuals with incidentally diagnosed placenta accreta spectrum at term vaginal delivery. This was a retrospective cohort study investigating the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 8,694,669 term vaginal deliveries from January 2016 to December 2019. Exclusion criteria included previous uterine scar, placenta previa, and preterm delivery. Exposure was assigned by the diagnosis of placenta accreta spectrum. The main outcomes were: (1) incidence rate, (2) clinical and pregnancy characteristics, and (3) maternal morbidity related to unsuspected placenta accreta spectrum at vaginal delivery. Multivariable binary logistic regression analysis and inverse probability of treatment weighting were fitted for statistical analysis. Unsuspected placenta accreta spectrum was reported in 1 in 3797 vaginal deliveries. In a multivariable analysis, the following were associated with increased likelihood of unsuspected placenta accreta spectrum (all, P<.05): (1) patient factor with older age, (2) uterine factors such as uterine anomaly and uterine myoma, (3) pregnancy factors including early-term delivery and previous recurrent pregnancy losses, and (4) fetal factors of in utero growth restriction and demise. Of those, uterine anomaly had the greatest association with unsuspected placenta accreta spectrum (adjusted odds ratio, 6.23; 95% confidence interval, 4.20-9.26). In a propensity score-weighted model, patients in the unsuspected placenta accreta spectrum group were more likely to have hemorrhage (65.2% vs 4.1%), blood product transfusion (21.3% vs 0.6%), hysterectomy (14.9% vs <0.1%), coagulopathy (2.9% vs 0.1%), and shock (2.9% vs <0.1%) compared with those without placenta accreta spectrum. Patients in the unsuspected placenta accreta spectrum group were also more likely to receive manual removal of the placenta compared with those in the non-placenta accreta spectrum group (25.1% vs 0.6%). This study suggests that although unsuspected placenta accreta spectrum among patients undergoing term vaginal delivery is rare, it is associated with significant morbidity. The observed association between uterine anomalies and placenta accreta spectrum warrants further investigation.

Evaluation and Comparison of Sensitivity and Specificity of Ultrasonography in Placenta Accreta Diagnosis in the Second and Third Trimesters.

Ultrasound is the selected technique for the detection of placenta accreta spectrum (PAS). This method can detect PAS in 80%-50% of cases. This study aimed to assess and compare the sensitivity and specificity of ultrasonography in the diagnosis of PAS after the first trimester. In this prospective study that was performed in 2020-2021 on 79 patients at high risk of PAS, all cases underwent ultrasonography in both 18-22 weeks of gestational age (GA) and 32-34 weeks of GA for evaluation of accreta. As per the risk factors, the delivery plan for all mothers was cesarean section. During the cesarean section, the placenta was examined for accreta, and if it was attached to the uterus, a diagnosis of placenta accreta was ascertained and a total abdominal hysterectomy was performed if the patient's bleeding was not controlled during the operation. The final diagnosis of PAS was made based on the pathology report. Ultrasound evaluation for PAS in 18-22 weeks of GA had 79.17% specificity, 51.61% sensitivity, 61.54% positive predictive value, and 71.70% negative predictive value. Ultrasound imaging for PAS in 32-34 weeks of GA had 60.8% specificity, 90% sensitivity, 62.52% positive predictive value, and 90.33% negative predictive value. It should be concluded that PAS is a critical condition and if the patient is diagnosed in the second or third trimester, special strategies should be applied.

Diagnostic accuracy of Uterine Artery Doppler Velocimetry in Patients with Placenta Previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value > 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.

Value of 3D ultrasound flow imaging combined with serum AFP, β-hCG, sFlt-1 and CK in the diagnosis of placenta accreta

PurposeTo analyze the diagnostic value of placenta three-dimensional (3D) energy blood flow parameters combined with maternal serum AFP, β-hCG, sFlt-1 and CK levels for PA.Methods30 pregnant women with PA and 30 pregnant women with normal placenta were randomly selected in the Affiliated Maternal and Child Health Hospital of Nantong University from January 2021 to December 2021. Thereafter, the 3D energy ultrasound was applied to detect the placenta VI, FI and VFI. Moreover, the diagnostic value of different parameters combined with serum AFP, β-hCG, sFlt-1 and CK levels for PA was analyzed.ResultsMultivariate analysis results indicated that, gravidity > 2 and with/without placenta previa were the independent risk factors for PA (P < 0.05). In PA group, the AFP, β-hCG, CK, placenta VI, FI and VFI values were higher than those in non-PA group, while sFlt-1 was apparently lower than that in non-PA group. With the increase in PA degree, the serum AFP, β-hCG and CK levels increased. Meanwhile, serum sFlt-1 level was negatively correlated with PA degree. Serum AFP, β-hCG, sFlt-1, CK and placenta VFI showed prediction potency for PA, and their combined detection attained the optimal diagnostic value for predicting PA. ROC curve analysis suggested that, serum AFP, β-hCG, sFlt-1, CK and 3D ultrasound VFI value had the greatest AUC values in predicting PA, which might provide reference for the clinical diagnosis and disease evaluation of PA. Conclusion Serum AFP, β-hCG, sFlt-1, CK and placental VFI can increase the consistency in the diagnosis of PA. Serum markers combined with 3D ultrasound blood flow imaging can improve the sensitivity and specificity of prenatal diagnosis of PA, which provides an important reference for clinical diagnosis and treatment.

Comparison of T2-weighted and diffusion-weighted imaging for the diagnosis of placenta accreta spectrum abnormality.

Diffusion-weighted imaging (DWI) is feasible in prenatal imaging, and it exhibits better contrast between the placenta and the myometrium compared to T2-weighted (T2W) images. To compare magnetic resonance imaging (MRI) features of placenta accreta on T2W and DW imaging. In this retrospective study, 42 pregnant patients who underwent prenatal MRI were included. MRI was performed on a Siemens 1.5-T scanner. T2W and DWI sequences in the axial, sagittal, and/or coronal planes were compiled for review. Two radiologists independently interpreted T2W and DW images for placenta accreta. T2W and DWI scores were calculated based on the presence of features and graded as low, intermediate, and high risk. The association between imaging features and placental invasion on pathology was calculated using chi-square tests. Sensitivity, specificity, and positive and negative predictive values (NPV) were compared between T2W and DWI interpretations. Inter-reader agreement between the two radiologists for T2W and DWI scores was calculated using Cohen's kappa coefficient. Out of 42 pregnant patients, 10 were pathologically/surgically proven to have placenta accreta. There were no significant differences between T2W and DWI interpretations. Considering a cutoff >6 as positive, the T2W score had higher sensitivity (90% vs. 80%) and NPV (96.9% vs. 94.1%) than the DWI score. The specificity and positive predictive value were 100% for both scores. The inter-reader agreement of T2W score was higher (k = 0.943 vs. 0.882). T2W and DWI are comparable in diagnosing placenta accreta spectrum. T2W sequences have higher sensitivity, NPV, and inter-reader agreement than DWI.

Multidisciplinary Management of Placenta Accreta Avoiding Maternal Mortality in a High-Risk Center- Case Report

Background: Placenta Accreta (PA) constitute a spectrum of abnormal placentation associated with a significant increase in maternal morbidity and mortality. Antenatal diagnosis of PA has transcendental importance in the orientation of the multidisciplinary management showing a substantial reduction in hemorrhagic complications. Case Presentation: A patient of 36.4 weeks of gestation with ultrasound findings of placenta previa and a high probability of placenta increta was attended in our high-risk center. Cesarean section with hysterectomy was performed at 37 weeks. During the surgical procedure, it was found infiltration of the placenta up to the uterine serosa at the level of the uterine segment and adjacent bladder. A hysterotomy at the corpus of the uterus was performed and a healthy newborn was obtained. Ligation of the hypogastric arteries bilaterally and total abdominal hysterectomy was achieved. The patient received a transfusion of red blood cells, platelets, cryoprecipitates and fresh frozen plasma and required vasopressor support with favorable evolution and avoiding fetal and maternal complications. The review of this case highlights that the management by a multidisciplinary team reduces the complications and morbidity-mortality of patients with placenta accreta as it is currently a public health problem. Conclusions: The maternal-perinatal outcomes not only depend on the availability of prenatal diagnosis but also on the organization of this multidisciplinary group with the application of standardized management and providing care in high-risk centers.

Accuracy of Magnetic Resonance Imaging in Diagnosing Placenta Accreta: A Systematic Review and Meta-Analysis

Background The disease burden and incidence of placenta accreta are increasing worldwide. The morbidity and mortality associated with undiagnosed placenta accreta are both high, highlighting the important of early diagnosis and intervention. In recent years, increasing studies are exploring the diagnostic value of magnetic resonance imaging (MRI) for placenta accreta. Compared with traditional ultrasound, MRI has the advantages of high-resolution, multiangle imaging, and less influence by amniotic fluid and intestinal gas. However, the reported diagnostic accuracy among studies was inconsistent. Therefore, this study is aimed at exploring the diagnostic value of MRI for placenta accreta by systematic review and meta-analysis. Methods Relevant literature were systematically searched in PubMed, Ovid, Embase, ScienceDirect database, CNKI, and Wanfang database by using medical subject headings and relevant diagnostic terminologies such as sensitivity, specificity, likelihood ratio, receiver-operating characteristic curve, and area under the curve. The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve of the included literature were analyzed using stata 17.0 software. Publication bias of the included studies was assessed by Deek's funnel plot. Cochrane Q statistics and I2 statistics were used to test the heterogeneity. Results A total of 10 primary publications, comprising 4 retrospective studies and 6 prospective studies, were included in this meta-analysis. The gestational weeks of pregnant women ranged from 32 to 35 weeks, and the sample size ranged from 37 cases to 575 cases. Only 4 studies used the blind method in the process of clinical diagnosis by MRI. The combined sensitivity, specificity, and area of curve under summary receiver-operating characteristic for the diagnosis of placenta accreta by MRI were 0.88 (95% CI, 0.79-0.93), 0.79 (95% CI, 0.68-0.87), and 0.91 (95% CI, 0.88.-0.93), respectively. The combined positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and diagnostic score were 4.17 (95% CI, 2.62-6.66), 0.16 (95% CI, 0.09-0.29), 26.61 (95% CI, 10.22-69.28), and 3.28 (95% CI, 2.32-4.24), respectively. No publication bias was noted. Conclusion Diagnosis of placenta accreta by MRI has good accuracy and predictive value that warrants clinical promotion.

Timing of delivery for placenta accreta spectrum: the Pan-American Society for the Placenta Accreta Spectrum experience

The Society for Maternal-Fetal Medicine recommends cesarean delivery with potential hysterectomy scheduled in the late preterm period between 34 0/7 and 35 6/7 weeks of gestation for prenatally suspected placenta accreta spectrum. We aimed to investigate clinical compliance with the recommended delivery timing window for placenta accreta spectrum and its impact on maternal and neonatal outcomes. We performed a retrospective multicenter review of data from referral centers within the Pan-American Society for Placenta Accreta Spectrum. Patients with placenta accreta spectrum with both antenatal diagnosis and confirmed histopathologic findings were included. We investigated adherence to the Society for Maternal-Fetal Medicine-recommended gestational age window for delivery, and compliance was further stratified by scheduled and unscheduled delivery. We compared the outcomes for patients with scheduled delivery within vs immediately 2 weeks outside the recommended window. Among 744 patients with a prenatal diagnosis of placenta accreta spectrum and placental histopathologic confirmation, 488 (66%) had scheduled delivery. Among all prenatally diagnosed placenta accreta spectrum patients, 252 (39%) delivered within the recommended window of 34 0/7 and 35 6/7 weeks gestation. For the subgroup of patients who underwent scheduled delivery (n=426), 209 (49%) had delivery in this window, 120 (28%) delivered before 34 weeks, and 97 (23%) delivered at or later than 36 weeks. In the patients with scheduled delivery, 27% of placenta accreta spectrum patients with accreta delivered in the 2 weeks immediately after the recommended window (36 0/7-37 6/7 weeks), and 22% of placenta accreta spectrum pregnancies with increta/percreta delivered in the 2 weeks immediately before the recommended delivery (32 0/7-33 6/7 weeks). The maternal outcomes among those who delivered within the recommended range vs those delivering 2 weeks before and after the recommended range were similar, regardless of placenta accreta spectrum severity. Less than half of placenta accreta spectrum patients had scheduled delivery within the recommended gestational age of 34 0/7 to 35 6/7 weeks. The reasons for deviation from recommendations and the risks and benefits of individualized timing of delivery on the basis of risk factors and predicted outcomes warrant further investigation.

Diagnostic accuracy of uterine artery doppler velocimetry in patients with placenta previa

Background; The placenta previa (PP) is an obstetric problem in which the placental tissue is improperly located inside the lower uterine segment. Aim and objectives: was to see how effective uterine artery Doppler velocimetry was in detecting unusually morbidly adhering placentas in patients who had had one or more prior caesarean sections with placenta previa. Subjects and methods; Cross-sectional research of 100 patients was undertaken in the Department of Gynecology and Obstetrics, El- Sayed Galal Hospital, AL- Azhar University. Result; Our results showed highly statistically significant correlation between the presence of abnormal lacunae and histopathological confirmation (P-value &gt; 0.001). In addition, the overall Sensitivity, specificity, PPV, NPV and accuracy were 90%, 100%, 100%, 64.2%, 91.6%. This criterion showed very high sensitivity and specificity with very high positive predictive value and accuracy to become the most important criteria, Conclusion; As a result of this, we conclude that the accuracy of abnormal placental lacunae, loss of the reto-placental clear zone, myometrial thinning, and utero-vesical hypervascularity are the most critical ultrasound criteria for diagnosing placenta accreta in patients who had a previous CS with a placenta previa overlying the previous uterine scar.