Characterization of placenta accreta using transvaginal sonography and color Doppler imaging

Lerner, Jodi P.; Deane, Sandra; Timor‐Tritsch, I. E.

doi:10.1046/j.1469-0705.1995.05030198.x

Cited by 141 publications

(91 citation statements)

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“…[5][6][7][8][9][10][11][12][13][14][15] Other studies have indicated the utility of color Doppler sonography for the assessment of placenta accreta and the identification of vasa previa. 16,17 The current study shows that the administration of Levovist enhances the color Doppler signal of the placenta. Since it is not expected that Levovist, as an intact microbubble with a mean diameter of 2 to 3 µm, should cross the blood-placenta barrier, enhancement should be limited to the maternal circulation.…”

Section: Discussionmentioning

confidence: 54%

Assessment of fetal and placental blood flow in primates using contrast enhanced ultrasonography.

Schmiedl

Komarniski²,

Winter³

et al. 1998

Journal of Ultrasound in Medicine

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Ultrasonographic contrast agents that stay within the vascular space and do not cross the placenta may permit differentiation between the maternal and fetal portions of the placenta and may be clinically useful for diagnosis of placental abnormalities. This study was performed to assess the effects of Levovist (Schering AG, Berlin) on the placental circulation and to determine whether hemodynamic effects on the fetus occur. Ten studies were performed in five pregnant macaques (median weight, 9.15 kg; range, 6.15 to 11 kg; median gestational age, 121 days; range, 34 days to term) under anesthesia. Gray scale, color, and duplex Doppler sonographic scans of the fetus and placenta were acquired using a 5 MHz curved array transducer. Fetal heart rate, resistive index, and systolic‐diastolic ratios were measured in the fetal middle cerebral artery, aorta, umbilical artery, and uterine artery before and after administration of contrast agent. The following dose regimen was tested: 5 ml of physiologic saline solution followed by 0.1 ml/kg of 300 mg/ml Levovist (diagnostic dose), 0.5 ml/kg of 400 mg/ml Levovist (maximum dose), and 5 ml physiologic saline solution. The order of diagnostic dose and maximal dose was randomized among animals. Color enhancement of the basal portions of the placenta was documented after administration of contrast agent. Heart rate and middle cerebral artery systolic‐diastolic ratio did not change between baseline and injections. A 7% decrease of the resistive index from baseline to maximum dose was measured in the uterine artery (not significant). A 7.7% decrease in the systolic‐diastolic ratio from baseline to maximum dose was recorded in the umbilical artery. However, an identical change was measured after saline solution was injected. The resistive index in the aorta increased by 2.6% from baseline to maximum dose, a change that was not significant (P > 0.5). Ultrasonographic contrast enhancement of the maternal circulation in placenta is demonstrated to be without significant effects on the fetal circulation as measured in this limited population.

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Section: Discussionmentioning

confidence: 54%

Assessment of fetal and placental blood flow in primates using contrast enhanced ultrasonography.

Schmiedl

Komarniski²,

Winter³

et al. 1998

Journal of Ultrasound in Medicine

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“…9 The advent of Colour Doppler improved the diagnostic accuracy of conventionalgrayscalesonography. 5,7,8 The colour Doppler criteria suggestive of placenta accrete have been first described by Chou et al 8 They include:…”

Section: Discussionmentioning

confidence: 99%

“…The antenatal detection rate of placenta accreta (a collective term for accreta, increta and percreta) on ultrasound varies in the literature, ranging from 33% to 100%. 4,5 The Gray-scale sonography has been shown to be an excellent tool, with a sensitivity reported in the range of 77% to 87%, specificity of 96% to 98%, a positive predictive value (PPV) of 65% to 93%, and a negative predictive value (NPV) of 98%. 6 The use of colour Doppler and/ or power Doppler has been reported to improve the sensitivity and specificity of grey scale ultrasound.…”

Section: Introductionmentioning

confidence: 99%

“…6 The use of colour Doppler and/ or power Doppler has been reported to improve the sensitivity and specificity of grey scale ultrasound. 5,7,8 We conducted this study with the aim to evaluate the efficacy of colour Doppler imaging in the prediction of placenta accreta in the antenatal period and maternal and perinatal outcome of this dreaded condition.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of colour doppler imaging in prediction of placenta accrete

Agarwal

Bhaskaran

Gupta

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: In present scenario of increasing cases of previous caesarean section the diagnosis of Placenta accreta preoperatively is of great value to the attending obstetrician. This helps in preparing, counselling the patient and also in assembling a multidisciplinary team for effective peripartum clinical management of these patients to prevent maternal morbidity and mortality.Methods: One hundred patient with persistent placenta previa after 28 weeks gestation were screened by grey scale B mode sonography. In suspicious cases of placenta accreta, further assessment by colour Doppler ultrasound was done. The color doppler imaging (CDI) criteria used were - diffuse intra parenchymal placental lacunar flow, focal intra parenchymal placental lacunar flow, bladder-uterine serosa interphase hypervascularity, prominent sub-placental venous complex and loss of sub-placental vascular signal in areas lacking peripheral sub-placental hypoechoic zone. Patients were prospectively followed up till delivery and the CDI findings were analysed with reference to final diagnosis made during caesarean section.Results: Six of hundred patients exhibited characteristic CDI patterns highly specific for placenta accreta according to the criteria used. In all 6 patients, morbidly adherent placenta was present intraoperatively. The sensitivity and specificity of CDI in the diagnosis of placenta accreta in presentstudy was 100%. Caesarean hysterectomy was required in five patients. Patients with CDI features of lacunar flow had higher incidence of blood loss, transfusion requirements and need for caesarean hysterectomy compared to patients with nonlacunar flow. The remaining 94 patients with placenta previa, not suspicious for placenta accreta on sonography underwent uncomplicated caesarean section.Conclusions: The use of CDI along with conventional grey-scale sonography improves the diagnostic accuracy for prediction of placenta accreta in patients with persistent placenta previa.

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“…Avanços recentes na US com dopler colorido e power Doppler permitiram o estudo dos vasos e a mensuração da velocidade e fl uxo do sangue placentário. Os padrões de pulsatilidade venosa associados à presença de lacunas venosas e ao fl uxo venoso complexo retroplacentário são considerados critérios doplerfl uxométricos para placenta acreta 2,11,12 . Achados na RM de acretismo placentário, como o hipersinal placentário invadindo o miomé-trio, foram primeiramente descritos em 1992 13 .…”

Section: Total 8 7 15unclassified

Valor da ressonância magnética no diagnóstico antenatal do acretismo placentário

Francisco¹,

Goldman²,

Faria³

et al. 2006

Rev. Bras. Ginecol. Obstet.

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RESUMOObjetivos: estabelecer os principais sinais de acretismo placentário na ressonância magnética (RM) em gestantes com suspeita clínica e avaliar a utilidade do método. Métodos: estudo prospectivo, transversal em 15 pacientes com suspeita de acretismo placentário. O período compreendido foi de março de 2003 a fevereiro de 2006. A idade gestacional variou de 20 a 31 semanas. Todas as pacientes realizaram RM com estudo dirigido para placenta e haviam sido submetidas à ultra-sonografi a (US) prévia ao exame. Todas as peças foram encaminhadas para estudo anátomo-patológico (AP). Os exames foram realizados nos equipamentos Magnetom Impact e Sonata Maestro Class Siemens ® , adquiridas as seqüências HASTE, TURBO FISP, nos planos axial, sagital e coronal e gradiente echo (GE ® ) pré-e pós-contraste dinâmico no melhor plano de aquisição. A análise das imagens foi realizada por dois radiologistas em consenso. Resultados: a idade gestacional média das pacientes foi de 24,3 semanas. Foram estudadas sete placentas prévias centro-totais (47%), seis placentas corporais anteriores (40%) e duas placentas corporais posteriores (13%). A US foi positiva em 80% dos casos e a RM em 53% dos casos. No entanto, a US apresentou concordância fraca com o AP pelo teste de kappa (11%), com sensibilidade de 75%, especifi cidade de 14%, valor preditivo positivo (VPP) de 50% e valor preditivo negativo (VPN) de 33%. Já a RM teve concordância excelente com o AP (0,86), com sensibilidade de 100%, especifi cidade de 86% , VPP de 89% e VPN de 100%. Conclusões: a RM é útil na identifi cação do acretismo placentário. Os principais sinais na RM do acretismo placentário são: o hipersinal transmural, a descontinuidade da parede miometrial nas seqüências rápidas e a identifi cação dos vasos invadindo o miométrio nas seqüências dinâmicas. PALAVRAS-CHAVE:Placenta acreta/diagnóstico; Imagem por ressonância magnética ABSTRACT Purpose: to establish the main signs of placental accretism in magnetic resonance imaging (MRI) in patients with clinical suspicion and to estimate the benefi t of this method. Methods: prospective transversal study with 15 patients suspected of placental accretism, referred between March 2003 and February 2006. Gestational age varied from 20 to 31 weeks. All patients underwent MRI to study the placenta and had previously done an ultrasonography. Material was sent to histological study. MRI was done on Magnetom Impact and Sonata Maestro Class Siemens ® , with acquired sequences HASTE, TURBO SPIN in axial, sagittal, coronal planes and echo gradient (GE ® ), pre-and post-dynamic contrast in the best plan for acquisition. Images were analyzed by a team of two radiologists. Results: mean gestational age was 24.3 weeks. We studied seven placenta previa (47%), six anterior placentas (40%) and two posterior placentas (13%). Ultrasonography was positive in 80% of the palcentas and MRI in 53%. However, echography had a low concordance with anatomic pathological studies by Kappa test (11%), revealing 75% of sensitivity, 14% of specifi city, 50%...

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Characterization of placenta accreta using transvaginal sonography and color Doppler imaging

Cited by 141 publications

References 0 publications

Assessment of fetal and placental blood flow in primates using contrast enhanced ultrasonography.

Assessment of fetal and placental blood flow in primates using contrast enhanced ultrasonography.

Efficacy of colour doppler imaging in prediction of placenta accrete

Valor da ressonância magnética no diagnóstico antenatal do acretismo placentário

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