Prenatal Diagnosis Of Placenta Accreta Research Articles

The Role of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of the Adherent Placenta: An Observational Study.

Introduction Placenta accreta is an important factor responsible for maternal morbidity and mortality and is commonly associated with emergent postpartum hysterectomy. The precise prenatal diagnosis of affected pregnancies allows optimal obstetric management. Ultrasonography (USG) and magnetic resonance imaging (MRI) are the only diagnostic modalities available for the prenatal diagnosis of placenta accreta. Objective This study aims to evaluate the accuracy of USG and MRI in diagnosing adherent placenta. Methods Thirty females with placenta previa or a history of previous cesarean sections were evaluated with USG at 28-30 weeks, followed by MRI. The findings of USG and MRI were compared with the intra-operative findings (gold standard) as determined at surgery and by pathological examination. Results Abnormal bridging vessel (n = 24; 80%) was the most common finding seen on USG, whereas abnormal bulge (n = 22; 73.3%) and heterogenous placenta (n = 21; 70%) were the most common findings seen on MRI. The sensitivity of USG and MRI was in the range of 86.7%-92.9% and 92.9%-100%, respectively, in diagnosing three types of adherent placenta. The positive predictive values (PPV) of USG and MRI were in the range of 86.7%-86.7%and93.8%-100%, respectively, in diagnosing three types of adherent placenta. The accuracy of USG and MRI was in the range of 86.7%-96.7% and 96.7%-100%, respectively, in diagnosing three types of adherent placenta. Conclusion MRI helps to accurately classify placental invasion according to depth, as can be seen from the results of the present study, where the MRI technique was more accurate in diagnosing three types of adherent placenta.

Sonographic Features in the Placenta Accreta Spectrum

Background: Abnormally invasive placenta is defined as abnormal adhesion to the implantation site, it is a spectrum of abnormal placentation that leads to obstetric hemorrhage, knowledge of risk factors and ultrasound evaluation is what allows antenatal diagnosis allowing transfer to specialized centers, surgical planning, and modifying the maternal outcome, causing a decrease in maternal morbidity and mortality. Objective: To describe the main ultrasound signs found in patients diagnosed with abnormally invasive placenta. Methodology: Cross-sectional, descriptive, retrospective study, carried out through a bibliographic review in the databases of PubMed, Scholar.google.com, SciELO, MEDLINE, of articles published in English and Spanish between 1992 and 2020. The following methods were used. Keywords Mesh (Medical Subject Headings): placenta accreta; previous placenta; prenatal diagnosis; abnormally invasive placenta; placenta percreta; abnormally attached placenta. Inclusion criteria: case report-type articles that include pregnant patients with placenta accreta, associated risk factors and diagnostic evaluation sections, as well as a systematic review and meta-analysis on the prenatal diagnosis of placenta accreta, whose results were analyzed by analysis of frequency. Results: From the reviewed studies, it was observed that 66.7% of the patients had cesarean section as the predominant uterine surgery, ultrasound findings such as the loss of the hypoechoic zone in 35.7% of the cases; the presence of placental lacunae in 28.6%; myometrial thinning in 16.7%; as well as disruption of the uterus-bladder interface in 7.1%, in 54.8% intraoperative diagnosis was made. Conclusions: Placental accreta is an increasingly frequent pathology, the incessant search for alternatives to reduce maternal death, the ultrasound characterization of the most frequent signs help timely prenatal detection

Placenta accreta index as a predictor of placental invasion in cases of placenta previa

ObjectiveThis study aims to evaluate the role of the placenta accreta index in predicting placental invasion in patients with placenta previa.Patients and methodsThis study was carried on 60 pregnant women with placenta previa (after 30 weeks gestation). They were recruited from the Obstetrics and Gynecology clinic of Menoufia University hospitals and Shebin El Kom Teaching Hospital in the period from January 2019 to December 2020.ResultsPreterm labor was found in 15 (78.95%) patients in the accreta group and six (14.36%) patients in the nonaccreta group (P = 0.000). Hysterectomy was performed in 14 (73.68%) patients in the accreta group and four (9.76%) patients in the nonaccreta group (P = 0.000). Urological complications occurred in five (26.32%) patients in the accreta group and one (2.44%) patient in the nonaccreta group (P = 0.004). Blood transfusion was needed in 16 (84.21%) patients in the accreta group and seven (17.07%) patients in the nonaccreta group (P = 0.000). ICU transfer was needed in 10 (52.63%) patients in the accreta group and two (4.88%) patients in the nonaccreta group (P = 0.000).ConclusionsBoth grayscale and color Doppler ultrasound were very important in the prenatal diagnosis of placenta accreta to reduce maternal and perinatal mortality and morbidity, but color Doppler had higher sensitivity and specificity. Placenta accreta index score 4 can be used as a predictive cutoff value for prediction of placental invasion in patients with placenta previa. Placenta previa in current pregnancy, previous uterine scar, increased maternal age, number of dilation and curettage and number of pregnancies and labors, and the presence of previous history of placenta previa are all risk factors for placenta accreta, and placenta accreta is associated with increased postoperative morbidity. It is associated with increased blood loss, risk of blood transfusion, ICU admissions, wound sepsis, urological complications, and poor neonatal outcome.

Utility of Ultrasound and Magnetic Resonance Imaging in Prenatal Diagnosis of Placenta Accreta: A Prospective study

Objectives: determine the utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta. Methods: Thirty patients presented in the department of gynecology and obstetrics and fulfilling the inclusion criteria were selected for the study. Study was a cros sectional design conducted at department of Radiology, Nishtar Hospital Multan, from 1st January 2019 to 1st December 2019. Result: Only 10 patients with placenta accreta were positive on USG while other 9 patients were found to be negative; and 3 patients were misdiagnosed to have placenta accreta on USG. Table-IIOnly 15 patients with placenta accreta were positive on MRI while other 4 patients were found to be negative; and 2 patients were misdiagnosed to have placenta accreta on USG. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 52.6%, 72.7%, 76.9%, respectively. Conclusion: It can be concluded that there is no significant difference between MRI and USG in terms of accuracy for prenatal diagnosis of placenta accreta.

The Role of Color Doppler Ultrasonography and Magnetic Resonance in the Prenatal Diagnosis of Placenta Accrete

Background: Placenta accrete is a clinical and diagnostic challenge that is being with increasing frequency and may lead to catastrophic blood loss and related complications. Color doppler ultrasonography and magnetic resonance imaging are considered as specific imaging modalities and have very important role in the prenatal diagnosis of placenta accreta. Objectives: The aim of the current work was to evaluate the diagnostic value of color doppler ultrasonography and magnetic resonance imaging in the prenatal assessment of placenta accreta. Patients and Methods: This study was conducted on 40 pregnant women (from 32 to 40 weeks of pregnancy) with placenta previa and presented with manifestations of suspected placenta accreta. Their age ranged from 19 to 40 years with mean age of 31.8 years. All cases were subjected to ultrasound examination, but MRI was done in 33 cases prior to elective delivery. Results: Cases diagnosed of having placenta accreta were 18 out of 40 cases (45 %). Among those 18 cases; placenta found tobe accreta in 6 patients, increta in 7 patients and percreta in 5 patients. Our study showed high statistical significance between occurrence of Placenta accrete & prior uterine surgeries as a risk factor. Overall accuracy of ultrasound was 88%, while that of MRI was 85%. Ultrasound showed better specificity (86%) than that of MRI (81%), but MRI showed better sensitivity (92%) than that of ultrasound (89%). Conclusion: It could be concluded that both ultrasound and magnetic resonance have fairly good sensitivity and specificity for prenatal diagnosis of placenta accreta. Color doppler ultrasound remains the first primary screening imaging modality used to evaluate suspected placenta accreta and MRI is suggested as an alternative complementary tool to ultrasound in cases with inconclusive criteria.

Spontaneous uterine rupture due to cornual placenta percreta in unscarred uterus: A rare & challenging case

Spontaneous uterine rupture in unscarred uterus is a rare and catastrophic complication of pregnancy which can occur at any stage. The placental implantation at cornual end leading to placenta percreta, least common type of placenta accreta syndrome which causes uterine rupture in this case. Placenta accreta is defined as the abnormal attachment or invasion of the whole placenta or parts of it to the underlying musculature. It is a rare clinical condition with incidence ranging from 1: 500 to 1: 93000 deliveries. It is potentially life-threatening for both the mother and the fetus. Adherent placenta accounts for 7-10% of maternal mortality cases worldwide. Prenatal diagnosis seems to be a key factor in optimizing maternal outcome. Both ultrasonography & MRI have good sensitivity for prenatal diagnosis of placenta accreta. In this report we present the case of a G3P1011 with no known risk factors for adherent placenta who was diagnosed to have uterine rupture due to placenta percreta at cornual end leading to haemorrhagic shock. There was gross haemoperitoneum with evidence of uterine rupture on exploratoration which further proceeded with caesarean section & peripartum hysterectomy. Her postoperative period was uneventful. This case report emphasis the importance of keeping spontaneous uterine rupture due placenta percreta in the differential diagnosis of pregnant patient presenting with pain abdomen, hypovolumic shock and intrauterine death even in unscarred uterus.

Antepartum Evaluation of Placenta Accreta in Women with Placenta Previa by Color Doppler, Power Doppler Ultrasound and MRI: A Prospective Study

Abstract Background: Complications of placenta accreta include massive hemorrhage, damage to the uterus, bladder, ureters, and bowel, and often cesarean hysterectomy to control bleed-ing. Prenatal diagnosis of placenta accreta can help minimize the complication rate by enabling a surgeon to plan for the type of resources needed at the time of delivery. Aim of Study: The aim of the study is to study the role of color Doppler, power Doppler ultrasound and MRI in diagnosis of placenta accreta and the accuracy of each method in diag-nosis of the level of accretion. Material and Methods: Fifty women with criteria of have low lying placenta or placenta previa, have at least one previous uterine scar, have mild or no vaginal bleeding underwent color Doppler ultrasound, power Doppler ultrasound and MRI study at 34-36 weeks gestation. The result of degree of accretion compared for each radiological method by that found intraoperative. Results: Fifty pregnant women were included in this study, with a mean age 31.18±3.88. All patients proved by US to have placenta previa. Thirty two patients were diagnosed to be placenta accreta by color & power Doppler U/S, while 31 patient of the case were diagnosed to have placenta accreta by MRI. According to the pre-operative color & power Doppler and MRI findings and the intra-operative findings, color and power Doppler US has 96.4% sensitivity of in diagnosis of placenta accreta, while MRI has 82.1% sensitivity and com-bination of both imaging technique has the lowest sensitivity 78.6% but this combination has the highest specificity 90.9%, while MRI has the lowest specificity 63.6%. Conclusion: Color and power Doppler abdominal U/S are more sensitive in diagnosis of placenta accreta (96.4%) than MRI (82.1%). The combination of color and power Doppler U/S and MRI has the highest specificity (90.9%).

OC30.02: Diagnostic performance of obstetric ultrasound in prenatal diagnosis of placenta accreta in women with two or more Caesarean sections (ADoPAD study)

OC30.02: Diagnostic performance of obstetric ultrasound in prenatal diagnosis of placenta accreta in women with two or more Caesarean sections (ADoPAD study)

OC30.03: Diagnostic performance of ultrasound in prenatal diagnosis of placenta accreta in women without previous Caesarean section (ADoPAD study)

OC30.03: Diagnostic performance of ultrasound in prenatal diagnosis of placenta accreta in women without previous Caesarean section (ADoPAD study)

Role of ultrasound, Doppler, and MRI in the diagnosis of placenta accreta

Objectives The objectives of this study were to compare the accuracy of ultrasonography and MRI for prenatal diagnosis of placenta accreta (PA) and to compare the sensitivity and specificity of individual ultrasonographic and MRI markers in predicting placental invasion in cases of PA. Background PA is a significant cause of maternal morbidity and mortality, and at present it is the most common reason for emergent postpartum hysterectomy. Placenta previa and previous cesarean section are the two most important known risk factors for PA. Accurate prenatal identification of affected pregnancies allows optimal obstetric management. Ultrasonography still remains the diagnostic standard. However, in recent years, there has been increased interest in MRI in evaluating PA. Patients and methods A combined prospective and retrospective study was carried out on 20 pregnant women with persistent placenta previa (after 28 weeks gestation). All patients were subjected to history taking, complete medical examination, and ultrasound, Doppler, and MRI. Results The sensitivity and specificity of ultrasonography were 63.6 and 91.6%, whereas the sensitivity and specificity of MRI were 72.70 and 100%, respectively, in their ability to diagnose PA. Conclusion MRI hand-in-hand with ultrasound is important for the accurate diagnosis of placenta previa and the serious coexisting PA. Use of both modalities may provide more diagnostic information.

Effect of Prophylactic Placement of Internal Iliac Artery Balloon Catheters on Outcomes of Women With Placenta Accreta: An Impact Study

(Anaesthesia. 2017;72:853–858) Effective prenatal diagnosis of placenta accreta using ultrasound and magnetic resonance imaging has aided in the development of multidisciplinary management strategies for these patients, with the goal of obtaining the best outcomes for both the mother and neonate. Although cesarean hysterectomy is the predominant management technique chosen by obstetricians for abnormal placentation, massive hemorrhage is still relatively common and can lead to increased maternal morbidity and mortality. The goal of this study was to determine the efficacy of prophylactic placement of internal iliac artery balloon catheters for reducing hemorrhage and transfusion requirements in women with placenta accreta undergoing cesarean section.

New insights in the diagnosis of placenta accreta

In this case report we present a patient of 39 weeks pregnancy with a placenta accreta and discuss the new possilities of diagnosis of placental masses with respect to the related literature. The aim of our review was to assess the available useful procedures in an attempt to contribute to the decreasing the morbidity of this condition. Twenty-nine years-old gravida 2, para 0 was referred to our hospital at 38 weeks of gestation for planed delivery by cesarien section. She had a history of prior surgical pregnancy termination at 12 weeks of amenorrhea by dilation and curettage. The abnormal placentation was diagnosed during a routine sonographic examination at 22 weeks of gestation. 2D transvaginal ultrasound showed the total placenta praevia and the presence of multiple intraplacental lacunae. The placenta did not detach with gentle traction, so placenta accreta was suspected. Heavy bleeding hemorrage from the placental site induced the decision to perform an emergency hysterectomy. The prenatal diagnosis of placenta accreta before delivery allows multidisciplinary planning and minimize potential maternal or neonatal morbidity and mortality. Grayscale ultrasonography with the use of color Doppler is sufficient to diagnose placenta accreta. The knowlege of the ultrasound markers for placenta accreta is needed for both radiologist and obstetricians-gynecologist.

Maternal and neonatal outcomes among scheduled versus unscheduled deliveries in women with prenatally diagnosed, pathologically proven placenta accreta

Objective: To evaluate maternal and neonatal outcomes among scheduled versus unscheduled deliveries in cases of prenatally diagnosed, pathologically proven placenta accreta.Study design: Retrospective cohort of placenta accreta cases delivered in five University of California hospitals.Results: Of 151 cases of histopathologically proven placenta accreta, 82% were prenatally diagnosed. Sixty-seven percent of women underwent scheduled deliveries and 33% were unscheduled. There were no differences in demographics between groups except a higher rate of antepartum bleeding in the unscheduled delivery group (81 versus 53%; p = .003). Scheduled deliveries were associated with a later gestational age at delivery (34.6 versus 32.6 weeks; p = .001), lower blood loss (2.0 versus 2.5 l; p = .04), higher birth weight (2488 versus 2010 g; p < .001), shorter postpartum length of stay (4 versus 5 d; p = .03) and neonatal length of stay (12 versus 20 d; p = .005).Conclusion: Despite a prenatal diagnosis of placenta accreta, 1/3 of these cases require unscheduled delivery, portending poorer maternal and neonatal outcomes.

Multidisciplinary treatment of total placenta previa in a blood-refusal parturient for a religious reason.

Women with a history of previous cesarean delivery, presenting with a placenta previa, have become the largest group with the highest risk for placenta previa accreta.The objective of the study was to evaluate the accuracy of ultrasound imaging in the prenatal diagnosis of placenta accreta and the impact of the depth of villous invasion on management in women presenting with placenta previa or low-lying placenta and with 1 or more prior cesarean deliveries.We searched PubMed, Google Scholar, clinicalTrials.gov, and MEDLINE for studies published between 1982 and November 2016.Criteria for the study were cohort studies that provided data on previous mode of delivery, placenta previa, or low-lying placenta on prenatal ultrasound imaging and pregnancy outcome. The initial search identified 171 records, of which 5 retrospective and 9 prospective cohort studies were eligible for inclusion in the quantitative analysis.The studies were scored on methodological quality using the Quality Assessment of Diagnostic Accuracy Studies tool.The 14 cohort studies included 3889 pregnancies presenting with placenta previa or low-lying placenta and 1 or more prior cesarean deliveries screened for placenta accreta. There were 328 cases of placenta previa accreta (8.4%), of which 298 (90.9%) were diagnosed prenatally by ultrasound. The incidence of placenta previa accreta was 4.1% in women with 1 prior cesarean and 13.3% in women with ≥2 previous cesarean deliveries. The pooled performance of ultrasound for the antenatal detection of placenta previa accreta was higher in prospective than retrospective studies, with a diagnostic odds ratios of 228.5 (95% confidence interval, 67.2–776.9) and 80.8 (95% confidence interval, 13.0–501.4), respectively. Only 2 studies provided detailed data on the relationship between the depth of villous invasion and the number of previous cesarean deliveries, independently of the depth of the villous invasion. A cesarean hysterectomy was performed in 208 of 232 cases (89.7%) for which detailed data on management were available. Positive correlations were found in the largest prospective studies between the cumulative rates of the more invasive forms of accreta placentation and the sensitivity and specificity of ultrasound imaging but not with diagnostic odds ratio values. We found no data on the ultrasound screening of placenta accreta at the routine midtrimester ultrasound examination from the nonexpert ultrasound units.Planning individual management for delivery is possible only with accurate evaluation of prenatal risk of accreta placentation in women presenting with a low-lying placenta/previa and a history of prior cesarean delivery. Ultrasound is highly sensitive and specific in the prenatal diagnosis of accreta placentation when performed by skilled operators. Developing a prenatal screening protocol is now essential to further improve the outcome of this increasingly more common major obstetric complication.

Placenta accreta at 16 weeks associated with polyfibromatosis and consecutive hysterectomy. A case report

Placenta accreta is defined as an abnormal attachment of the placenta to the uterine wall with abnormal bond of the placental villi through the endometrium, directly into the myometrium. We report a case of a 38-year-old pregnant, gravida 3, para 1, with a previous cesarean delivery 10 years ago and known with uterine polyfibromatosis that presented to our emergency unit at 16 weeks of amenorrhea with diffuse abdominal ache and mild vaginal hemorrhage. The emergency ultrasound examination revealed uterine polyfibromatosis, incomplete miscarriage and suspected abnormal placentation. A dilation and curettage was performed. Due to persistent active vaginal bleeding and to the hemodinamicaly instability of the patient a second emergency ultrasound was performed and revealed a retained, adherent placenta on the anterior uterine wall. Therefore, an emergency laparotomy with abdominal hysterectomy was performed. Histopathology revealed a polyfibromatous uterus and placenta accreta adherent to isthmic fibroid tumors. Abnormal adherent placentation can significantly increase maternal hemorrhagic morbidity, thus when a prenatal diagnosis of placenta accreta is confirmed or suspected, it is necessary to implement a multidisciplinary approach.

Dynamic contrast enhanced MRI of the placenta: A tool for prenatal diagnosis of placenta accreta?

BackgroundUltrasound (US) is the primary imaging modality for the diagnosis of placenta accreta, but it is not sufficiently accurate. MRI morphologic criteria have recently emerged as a useful tool in this setting, but their analysis is too subjective. Recent studies suggest that gadolinium enhancement may help to distinguish between the stretched myometrium and placenta within a scar area. However, objective MRI criteria are still required for prenatal diagnosis of placenta accreta. The purpose of this study was to assess the diagnostic value of dynamic contrast gadolinium enhancement (DCE) MRI patterns for placenta accreta. Materials and methodsMR images were acquired with a 1.5-T unit at 30–35 weeks of gestation in women with a history of Caesarian section, a low-lying anterior placenta, and US features compatible with placenta accreta. Sagittal, axial and coronal SSFP (Steady State Free Precession) sequences were acquired before injection. Then, contrast-enhanced dynamic T1-weighted images were acquired through the entire cross-sectional area of the placenta. Images were obtained sequentially at 10- to 14-s intervals for 2 min, beginning simultaneously with the bolus injection. Functional analysis was performed retrospectively, and tissular relative enhancement parameters were extracted from the recorded images. The suspected area of accreta (SAA) was placed in the region of the previous scar, and a control area (CA) of similar size was placed on the same image plane, as far as possible from the SAA. Semi-quantitative analysis of DCE-MR images was based on the kinetic enhancement curves in these two regions of interest (ROI). Three tissular relative enhancement parameters were compared according to the pregnancy outcomes, namely time to peak, maximal signal intensity, and area under the enhancement curve. ResultsWe studied 9 women (43%) with accreta and 12 women (57%) with a normal placenta. All three tissular relative enhancement parameters differed significantly between the two groups (p < 10−3). ConclusionThe use of dynamic contrast-enhanced MRI at 30–35 weeks of gestation in women with a high risk of placenta accreta allows the extraction of tissular enhancement parameters that differ significantly between placenta accreta and normal placenta. It therefore provides objective parameters on which to base the diagnosis and patient management.

Outcome of Patients with Placenta Accreta at El Shatby Maternity University Hospital

Objective: The aim of this study was to determine the incidence, risk factors, and outcomes of management of patients with placenta accreta. Background Placenta accreta occurs when the placental implantation is abnormal. The marked increase in incidence has been attributed to the increasing prevalence of cesarean delivery in recent years. The most common theory is defective decidualization. The most important risk factor for placenta accreta is placenta previa after a prior cesarean delivery. The first clinical manifestation of placenta accreta is usually profuse, life-threatening hemorrhage. The recommended management of suspected placenta accreta is planned preterm cesarean hysterectomy with the placenta left in situ. Patients and methods: It’s a study of all cases of placenta accreta at El-Shatby Maternity University Hospital starting from 1/4/2016 till 1/10/2016. Selection of the cases will only be dependent upon their pregnancy gestational age above 28 weeks of gestation. Results: The incidence of placenta accreta was 1/75 cesarean deliveries. The ultrasonography and doppler had a false negative rate of 54.6% and a sensitivity of 45.2% in diagnosis of placenta accreta. The rate of blood transfusion was 79.6%. Uterine preserving procedures performed in 66%. Cesarean hysterectomy performed in 34%. Intensive care unit admission occurred in 27.3%. The mean gestational age at delivery was 33.8 ± 4.6 weeks’ gestation. 31.8% admitted to the neonatal intensive care unit. Conclusion: The incidence of placenta accreta increased due to the increasing rate of cesarean deliveries, prenatal diagnosis of placenta accreta is paramount, as most women are asymptomatic. Prenatal diagnosis allows time for a multidisciplinary team to make delivery plans, which will help decrease surgical complications.

Moving from intra partum to prenatal diagnosis of placenta accreta: a quarter of a century in the making but still a long road to go.

Moving from intra partum to prenatal diagnosis of placenta accreta: a quarter of a century in the making but still a long road to go.

Precesarean Prophylactic Balloon Catheters for Suspected Placenta Accreta: A Randomized Controlled Trial.

To examine the effect of prophylactic balloon catheters on bleeding morbidity among women with a prenatal diagnosis of placenta accreta. In a randomized trial, women with a prenatal diagnosis of placenta accreta were randomized to either preoperative prophylactic balloon catheters (intervention group) or to a control group. Other than placement of the prophylactic balloon catheters in the anterior division of the internal iliac arteries, the same multidisciplinary approach was used in both groups. The primary study outcome was the number of packed red blood cell (RBC) units transfused. To detect a mean reduction of three packed RBC units with the prophylactic balloon catheters, 12 women in each group were needed. Between January 2009 and March 2015, 27 women were randomized: 13 in the intervention group and 14 in the control group. Demographic and obstetric characteristics were similar between the groups. Six (46.2%) women in the intervention and seven (50.0%) in the control group underwent cesarean hysterectomy (P=.84). There were no significant differences between the intervention and control groups in the mean number of packed RBC units transfused, 5.2 (±6.2) and 4.1 (±3.8), respectively (P=.90), or in the calculated blood loss, 4,950 (±5,051) and 4,709 (±3,434) mL (P=.72). The number of women with blood loss greater than 2,500 mL, number of plasma products transfused, duration of surgery, peripartum complications, and hospitalization length did not differ significantly between the groups. Reversible adverse effects related probably to prophylactic balloon catheter insertion were noted in 2 of 13 (15.4%) women. In women with preoperative suspicion of placenta accreta, preoperative placement of prophylactic balloon catheters did not affect the number of packed RBC units transfused. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01373255. I.

Utility of ultrasound and magnetic resonance imaging in prenatal diagnosis of placenta accreta: A prospective study.

Context:Placenta accreta is the abnormal adherence of the placenta to the uterine wall and the most common cause for emergency postpartum hysterectomy. Accurate prenatal diagnosis of affected pregnancies allows optimal obstetric management.Aims:To summarize our experience in the antenatal diagnosis of placenta accreta on imaging in a tertiary care setup. To compare the accuracy of ultrasound (USG) with color Doppler (CDUS) and magnetic resonance imaging (MRI) in prenatal diagnosis of placenta accreta.Settings and Design:Prospective study in a tertiary care setup.Materials and Methods:A prospective study was conducted on pregnant females with high clinical risk of placenta accreta. Antenatal diagnosis was established based on CDUS and MRI. The imaging findings were compared with final diagnosis at the time of delivery and/or pathologic examination.Statistical Analysis Used:The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for both CDUS and MRI. The sensitivity and specificity values of USG and MRI were compared by the McNemar test.Results:Thirty patients at risk of placenta accreta underwent both CDUS and MRI. Eight cases of placenta accreta were identified (3 vera, 4 increta, and 1 percreta). All patients had history of previous cesarean section. Placenta previa was present in seven out of eight patients. USG correctly identified the presence of placenta accreta in seven out of eight patients (87.5% sensitivity) and the absence of placenta accreta in 19 out of 22 patients (86.4% specificity). MRI correctly identified the presence of placenta accreta in 6 out of 8 patients (75.0% sensitivity) and absence of placenta accreta in 17 out of 22 patients (77.3% specificity). There were no statistical differences in sensitivity (P = 1.00) and specificity (P = 0.687) between USG and MRI.Conclusions:Both USG and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. Both modalities have complimentary role and in cases of inconclusive findings with one imaging modality, the other modality may be useful for obtaining the diagnosis. CDUS remains the first primary modality for antenatal diagnosis of placenta accreta, with MRI reserved for cases where USG is inconclusive.