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Background Placenta accreta spectrum (PAS) represents life‐threatening conditions; however, early diagnosis reduces complications and mortality rates. Aims To develop and evaluate the accuracy of a simple sonographic screening test for PAS prediction. Materials and Methods A retrospective case–control study of 481 women with singleton pregnancies at 28 weeks or later, with a scarred uterus or placenta praevia, who underwent sonographic testing for PAS detection during 2010–2020. We compared demographic and sonographic features, and delivery outcomes between women who were and were not confirmed to have a PAS condition at delivery. We evaluated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and predictive probability for the sonographic screening model. Results Among all the women with at least one sonographic sign (large lacunae or loss of clear zone), the odds ratio (OR) of PAS was 21.7 (95% CI, 16.7–70.4), among those with placenta praevia (and at least one sonographic sign), the OR was 41.9 (95% CI, 15.8–111). For the screening model (the combinations of placental location (major or minor placenta praevia) with at least one sonographic sign (large lacunae or loss of clear zone)), sensitivity, specificity, PPV, NPV and predicted probability were 94.9% (85.8–98.9%), 91.5% (88.4–93.9%), 60.9% (50.1–70.9%), 99.2% (97.7–99.8%) and 92.3%, respectively. Conclusions A combination of simple ultrasound signs for PAS screening may be highly effective for prenatal assessment and prediction of placenta accreta. This screening test can be carried out as routine pregnancy follow‐up for women with risk factors for PAS.

IntroductionThe incidence of placenta accreta (PA) has markedly increased in the United States, from 1/30 000 in 1950 to 1/731 deliveries in 2011. Although placenta praevia after prior caesarean sections (CS) is the most important risk factor for PA, other risk factors make up 1–5% of PA occurrences. At our referral hospital, we use the pre‐caesarean prophylactic balloon catheter with or without post‐surgery embolisation in a hybrid room. Here, we evaluate the role of prior CS and placenta praevia on the outcome of this procedure.Materials and MethodsThis retrospective cohort analysis included 61 women during the years 2004–2016 with sonographic suspicion of PA who underwent balloon catheterisation prior to CS.ResultsEleven women had no previous CS (18%). Mean previous CS rate was 1.85. Six women (9.8%) had previous dilatation and curettage (D&C); 36.4% of women with no previous CS had previous D&C compared with 4% of women with previous CS (P = 0.008). Placenta praevia was sonographically diagnosed in 55 women (90.2%). There was a higher rate of caesarean hysterectomy in women with previous CS than in those without (32% vs 0%, P = 0.052) but no significant difference in blood product requirements (45.5% vs 66%, P = 0.303). There was no significant difference in hysterectomy rate, blood transfusion or surgery duration between women with and without placenta praevia (P = 0.648, 0.594, 0.995, respectively).ConclusionPrevious CS rather than placenta praevia is a strong indicator of hysterectomy in cases of PA. Different risk factors for PA do not affect blood transfusion rates or surgery duration.

Gestational trophoblastic neoplasms are a group of trophoblastic tumors that include choriocarcinoma (CC), epithelioid trophoblastic tumors (ETTs), and placental site trophoblastic tumors (PSTTs). Mixed gestational trophoblastic neoplasms include combinations of CCs with ETTs and/or PSTTs; combinations of ETTs and PSTTs have also been described. This report describes the case of a 49-yr-old female with mixed ETT and PSTT discovered due to menstrual delay and a positive beta-human chorionic gonadotropin in serum 11 yr after normal pregnancy; it is an asymptomatic recurrence of the neoplasm after 2 yr. Moreover, only the ETT recurred without evidence of PSTT by biopsy and without any increase in human chorionic gonadotropin levels, even though human chorionic gonadotropin was positive in the first onset of the disease. We also reviewed published English literature, which revealed that there are only 36 cases of mixed trophoblastic tumors to date, of which pure mixed ETT and PSTT were reported only in four cases including our case. The most common combination is CC admixed with an ETT (52%), followed by CC with PSTT in 30.5%. CC admixed with an ETT and/ or PSTT account for 83% of the cases, of which pure mixed ETT and PSTT were reported only in 4 cases (11%). The rarity of this condition entails reporting of all cases to facilitate future research and clinical management.