Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: A survey of 82 cases

Abstract

Background:Placenta adhesive disorder (PAD) is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities.Objective:The purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of PADs.Materials and Methods:In this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant.Results: Mean maternal age was 31.42±4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases (96%). The diagnosis of placenta adhesive disorder was found in 17 cases (21%). Doppler sonography sensitivity was 87% and MRI sensitivity was 76% (p=0.37). Doppler sonography specificity was 63% and MRI specificity was 83% (p=0.01).Conclusion:Women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity.

Hysterectomy with Fetus In Situ for Uterine Rupture at 21-Week Gestation due to a Morbidly Adherent Placenta

“…Doppler imaging demonstrates regular continuous retroplacental myometrial blood flow. Findings on ultrasonography that can be seen in the spectrum of morbidly adherent placenta include thinning of the myometrium, loss of the subplacental clear space, disruption of the serosa-bladder wall interface, presence of an exophytic mass beyond the uterine serosa, increased retroplacental vascularity, increased vascularity along the bladder wall, and placental lacunae [ 7 ]. A heterogenous appearing placenta due to the presence of lacunae, which appear as vascular structures demonstrating turbulent flow on Doppler, has the highest sensitivity, ranging from 78 to 93% after 15-week gestational age.…”

Abnormalities of placenta implantation

“…Accurate prenatal diagnosis of abnormal placentation is paramount for optimal management, ensuring that a multidisciplinary team is prepared for the delivery . Transabdominal ultrasound is the primary technique used to rule‐out abnormal placentation; however, there are limitations to this technique and false positive results may occur . The addition of color Doppler to the ultrasonography examination increases the sensitivity for the diagnosis of abnormal placentation .…”

“…Transabdominal ultrasound is the primary technique used to rule‐out abnormal placentation; however, there are limitations to this technique and false positive results may occur . The addition of color Doppler to the ultrasonography examination increases the sensitivity for the diagnosis of abnormal placentation . Ultrasound and magnetic resonance imaging (MRI) appear to have similar sensitivity for the diagnosis of abnormal placentation.…”

“…Ultrasound and magnetic resonance imaging (MRI) appear to have similar sensitivity for the diagnosis of abnormal placentation. In cases of posterior accreta, MRI is more useful than the ultrasound examination . By imaging, the diagnosis of abnormal placentation is characterized by the disappearance of the normal subplacental clear space adjacent to the uteroplacental interface, extreme thinning of the underlying myometrium, discontinuity of low signal zone in the gap between bladder and the uterus, irregularities of the bladder wall and vascular changes within the placenta.…”

Exactitud de los hallazgos ecográficos 2D más ecografía Doppler para el diagnóstico de acretismo placentario clínico en gestantes con factores de riesgo

“…In Colombia, there are three reports related to ultrasound diagnosis of placenta accreta, all of them with limitations in terms of patient number and selection and the type of information provided (31)(32)(33). On the other hand, there are reports that describe good accuracy of Doppler ultrasound in placenta accreta (34).…”