Suspicion Of Placenta Accreta Research Articles

Clinical and Radiological Features Associated with Bladder Invasion and Need for Urological Intervention in Suspected Placenta Accreta

Purpose: We investigated clinical and radiological predictors of bladder invasion and need for urological intervention in pregnant women with suspected placenta accreta. Methods: We conducted a retrospective study including pregnant women with ultrasonographic (US) suspicion of placenta accreta. Surgical and clinical data were reviewed, and seven US parameters were used to classify the patients. A single and expert radiologist reviewed Magnetic Resonance Imaging (MRI) and used nine parameters for classification. Chi-square, Fisher´s exact test or Mann-Whitney and logistic regression were used to calculate the risk of bladder invasion and need of cystorrhaphy for continuous variables. Results: Twenty-seven patients fulfilled all the inclusion criteria, and the histological diagnosis of placenta accreta, increta or percreta was performed in 5, 8 and 14 patients respectively. Regarding clinical data, the risk of placenta percreta increases 35.7% for each maternal year and three times for each cesarean section. Bilateral prophylactic double J catheter was attempted in all patients, but successful in 81,48%, mostly in percreta patients. There were signs of bladder invasion in 9 patients, all with placenta percreta. The risk of bladder injury suture increases by 26.41% for each maternal year, in the same way, increase 5.7 times for each cesarean section. Conclusion: Maternal age and number of cesareans are the only direct predictors of the depth of placental invasion and risk of urological intervention. None US or MRI parameters had a predictive role in the depth of invasion or to the risk of cystorrhaphy.

Rebound hyperkalemia after cessation of ritodrine in a parturient undergoing cesarean section

A 36-year-old parturient with a suspicion of placenta accreta under tocolytic therapy with ritodrine infusion underwent emergency cesarean section under general anesthesia with propofol, ketamine, and remifentanil because massive bleeding was anticipated. The ritodrine infusion was discontinued 1 h before cesarean section. The baby was delivered 6 min after induction of anesthesia. However, after the manual removal of the placenta from the uterus, the bleeding was massive and uncontrollable. We rapidly transfused crystalloid, colloid, and red blood cells through potassium removal filter. Hyperkalemia (5.8 mmol/L) was detected just before blood transfusion. One hour later, hemostasis was still difficult, and hyperkalemia was promoted (6.1 mmol/L). Thus, glucose insulin therapy started with intravenous furosemide to treat hyperkalemia. Gynecologists decided to induce the Bakri balloon tamponade for the treatment of postpartum hemorrhage. At the end of surgery, plasma potassium level also reduced to 5.5 mmol/L. In the ICU, the bleeding still continued, and then radiologists performed bilateral internal iliac artery embolization for full hemostasis. Postoperative plasma potassium level was stable and 3.3 mmol/L in the next morning. Although one of the common adverse reactions of ritodrine is hypokalemia, we should also beware of a rebound hyperkalemia after its cessation.

Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta

Objective: To compare the ability of magnetic resonance imaging (MRI) and ultrasound (US) in the diagnosis of placenta accreta, to examine the success of various sonographic and MRI features to correctly predict invasive placenta, and to define a specific role for MRI in placenta accreta.Methods: After Institutional Review Board approval, a blinded retrospective review was undertaken of US and MRI findings from 45 patients who had an obstetrical US and placental MRI between August 2006 and January 2012. Correlation with clinical history and pathologic findings was performed.Results: US and MRI had similar sensitivity, specificity and positive and negative predictive values for placenta accreta. The best predictors of invasion by US were loss of the myometrial mantle, increased intraplacental vascularity and loss of the bladder wall echogenicity. The best predictors of invasion by MRI were loss of retroplacental myometrial mantle, a heterogeneous placenta, and intraplacental hemorrhage. Body mass index (BMI) did not affect the ability to make a diagnosis by either US or MRI. MRI proved effective in better evaluation of a posterior placenta with suspicion of placenta accreta. There was modality disagreement in 11 of 45 cases and MRI was correct in 9 of these 11 cases, all true negative (TN) cases.Conclusions: MRI should be considered in any case with posterior placenta previa and suspicion of accreta, in any case with clinical suspicion for accreta and discordant US findings, and in any case in which percreta is suspected.

Conservative Surgical Management of Placenta Previa and Accreta. A Case Report

Background: Placenta previa is a known associated risk factor for the presence of placenta accreta. Therefore, when there is a diagnosis of placenta previa, there should also be a high suspicion for placenta accreta. Case: A 32-year-old pregnant woman had massive hemorrhage caused by placenta previa and accreta during cesarean section. She was successfully treated with uterine balloon tamponade and uterine artery ligation. Conclusion: In order to avoid postpartum hemorrhage and hysterectomy protocols, the alternative bilateral uterine arterial ligation, Bakri balloon tamponade and, if necessary, methotrexate therapy, can be successfully applied.

Virtual bronchoscopy in the fetus

The term ‘virtual bronchoscopy’ describes the creation and evaluation of representations of the bronchial tree and surrounding structures using spatial information derived from imaging sources other than the bronchoscope itself. Initially, this referred to two-dimensional and later three-dimensional (3D) bronchial tree representations generated from computed tomography images. However, virtual bronchoscopy can now also be performed using data from magnetic resonance imaging (MRI). Several software options are available that can be used to generate accurate and realistic renderings of the bronchial tree 1–3 . Advances in imaging technology have led to vast improvements in fetal evaluation. Ultrasound examination is the primary method of fetal assessment because it is patient-friendly, effective, cost-efficient and considered to be safe 4 . MRI is generally used when ultrasound cannot provide sufficiently high-quality images. It offers high-resolution fetal imaging with excellent contrast that allows visualization of internal tissues 5 .I n this article we describe virtual bronchoscopy performed in a normal fetus that underwent MRI at 28 weeks’ gestation due to placenta previa with suspicion of placenta accreta. MRI examination was performed using a 1.5-T scanner (Siemens, Erlangen, Germany). The protocol involved a T2-weighted sequence in the three planes of the fetal body (HASTE; repetition time (TR), shortest; echo time (TE), 140 ms; field of view, 300–200 mm; matrix, 256 × 256; slice thickness, 4 mm; acquisition time, 17 s; 40 slices). In addition, we applied a 3D, T2-weighted TrueFISP sequence in the sagittal plane (TRUFI; TR/TE = 3.02/1.34; voxel size 1.6 × 1.6 × 1. 6m m 3 ; flip angle = 70 ◦ ; parallel acquisition techniques 2; acquisition time, 0.26 s) (Figure 1). The entire examination time did not exceed 20 min. The 3D MRI datasets were reconstructed to produce an interactive surface model of the fetal respiratory tract that could be viewed from any angle. Firstly, a 3D model of the fetal airway was created from the overlapping image layers generated by MRI using the software Mimics (Materialise, Leuven, Belgium), which allowed the surface of the airway to be delineated using contrast detection in the relevant areas of interest. The 3D model that was generated was exported using the standard triangular language file format and then converted into an OBJ file using the MAYA 3D modeling software (Autodesk, San Rafael, CA, USA) 6,7 . This program allows the virtual positioning of observation cameras while working with multiple on-screen windows. After the development of the 3D model, the software allows the user to determine the best positioned viewpoints for visualization of the 3D model (Figure 2) and also facilitates the adjustment of lighting parameters to improve contrast resolution. Using the navigation mode it is also possible to perform virtual bronchoscopy to visualize the upper respiratory tract from the pharynx downwards through the tracheobronchial tree (Videoclip S1) with a quality similar to that which could be obtained by videotaped bronchoscopy. We have demonstrated that MRI data can be used to create a 3D model of the respiratory tract in a normal fetus. We believe that this technique could become a useful tool for the assessment of fetal airway patency.

135: Factors associated with emergent delivery in women with placenta previa and strong suspicion for placenta accreta

135: Factors associated with emergent delivery in women with placenta previa and strong suspicion for placenta accreta