Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness

Abstract

The wide heterogeneity in terminology used to describe the grades of accreta placentation and differences in study design limits the evaluation of the accuracy of ultrasound imaging in the screening and diagnosis of placenta accreta. This review emphasizes the need for further prospective studies using a standardized evidence-based approach including a systematic correlation between ultrasound signs of placenta accreta and detailed clinical and pathologic examinations at delivery.

FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders,

“…However, this can lead to misleading conclusions, as adherent and invasive accreta placentation have very different outcomes and require different management. To compound this, although 80%–90% of prenatally diagnosed PAS are managed surgically, around half of the authors fail to report the extent of villous attachment or invasion after peripartum hysterectomy …”

“…Adding to the confusion is the wide heterogeneity in terminology used to describe the different grades of accreta placentation, including “placental adhesive disorders”, “abnormal placental adherence”, “advanced invasive placentation”, and “abnormal myometrial invasion” . A recent popular label used by clinicians reporting on the prenatal diagnosis of PAS has been “morbidly adherent placenta”, which was used in the 19th century to describe placental retention .…”

Emergency Peripartum Hysterectomy: 20-Year Experience of a University Hospital

“…Acil PH 23 hastaya uygulanmış ve 1000 doğumda 1,7 olarak tespit edildi. Peripartum histerektomi yapılan hastaların ortanca yaşı 30 (27)(28)(29)(30)(31)(32)(33), gravidası 3 (2-4), doğumdaki ortalama gebelik haftaları 36,37 (±4,47) ve ortalama doğum ağırlıkları ise 2825g (±1273,2g) idi. Peripartum histerektomi 7 (% 30,4) hastaya vajinal doğum sonrası 16 (% 69,6) hastaya ise sezaryen sonrasında uygulanmıştı (Tablo I).…”

“…Plasenta invazyon anomalilerinde ultrasonografi ile öngörü yapılması mümkündür. Yalnızca gri skala ultrasonografi ile tecrübeli uygulayıcılar tarafından plasenta previa veya aşağı yerleşimli anterior plasentası olan olgularda %86 ile %93 arasındaki duyarlılıklarda plasenta akreata tanısı konabilmektedir (29)(30)(31). Gri skala ultrasonografiye renkli Doppler ve 3 boyutlu ultrasonografi eklendiğinde ise deneyimli ellerde duyarlılık %97'ye kadar yükselebilmekte-dir (25).…”

Rotura uterina durante el segundo trimestre de gestación asociado a placenta percreta: presentación de un caso y revisión de la literature

“…[27,28] Como lo documentado en los reportes de caso revisados [2,4,10,14-16,18-19,22] la sospecha diagnostica de esta patología se tiene por medio de la ecografía, pudiendo coexistir en una misma paciente distintos grados de acretismo. [29] El uso de ecografía transabdominal puede encontrar solución de continuidad en el miometrio en el 35% de las mujeres con espesor <2,0 mm.…”