Diagnosis of placenta accreta spectrum using ultra‐high‐frequency probe and Superb Microvascular Imaging

Hasegawa, Junichi; Kurasaki, Akiko; Hata, Toshiyuki; Homma, Chika; Miura, Ayako; Kondo, Haruhiro; Suzuki, Nao

doi:10.1002/uog.20207

Cited by 29 publications

(12 citation statements)

References 7 publications

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“…reported a direct finding of shed decidual blood flows, and Hasegawa et al . reported an indirect finding of the unique properties of intraplacental chorionic blood vessels 10,11 . In addition, in our case, these findings were detected using a conventional transabdominal probe as opposed to high‐resolution 18‐MHz SMI.…”

Section: Discussionmentioning

confidence: 47%

Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: A case described using superb microvascular imaging

Horinouchi

Yoshizato

Kojiro-Sanada

et al. 2020

J of Obstet and Gynaecol

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We present a case of a 34‐year‐old pregnant woman with a prior cesarean delivery presenting with placenta previa. Placenta previa accreta was diagnosed from missing decidual flow signals using superb microvascular imaging (SMI). At 31 weeks' gestation, B‐mode ultrasonography showed that the placenta was attached to the anterior uterine segment, extending over the internal cervical os. In normally appearing myometrium, SMI demonstrated double layers of flow signals underneath the placental basal plate, corresponding to myometrial and decidual flows. The thin myometrium located on the bladder where sonolucent zones were not visible revealed three different flow patterns in the Doppler signals underneath the basal plate as follows: double layers (both myometrium and decidual tissues present); a single layer (myometrium alone) or no layers (decidual tissues missing). A cesarean hysterectomy was performed at 37 weeks, and histology confirmed the presence of placenta accreta.

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Section: Discussionmentioning

confidence: 47%

Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: A case described using superb microvascular imaging

Horinouchi

Yoshizato

Kojiro-Sanada

et al. 2020

J of Obstet and Gynaecol

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“…Hasegawa et al reported a case of PAS with enlarged blunt stem vessels and no peripheral tapered vessels, with absent SMI Doppler signals in the restricted area of placental accreta. 6 The pathologic findings confirmed infarction of the peripheral villi and absence of the IVS. The authors speculated vascularity of the peripheral villous tree and congested stem vessels due to damaged peripheral VV.…”

Section: Discussionmentioning

confidence: 83%

“…Mack et al reported a direct finding of missing decidual blood flows, and Hasegawa et al reported indirect findings of unique characteristics of intraplacental chorionic vessels. 5,6 We also diagnosed PAS by finding missing decidual tissues directly, using SMI. Spontaneous uterine rupture is rare in an undamaged uterus.…”

Section: Discussionmentioning

confidence: 99%

Peculiar blood flow profiles among placental chorionic villous vessels of an abnormally thick placenta in a case of systemic lupus erythematosus characterized using microvascular imaging

Inoue

Horinouchi

Yoshizato

et al. 2020

J of Obstet and Gynaecol

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We present a patient with systemic lupus erythematosus receiving long-term steroid therapy, who had myometrial thinning, markedly thickened placenta, and fetal growth restriction (FGR). Blood flow profiles of the myometrium, decidua and placental villous vessels (VV) were described using superb microvascular imaging (SMI) at 35 weeks' gestation. Images showed no decidual blood flow underneath the placenta sitting on a thin myometrium and sparse VV distribution and non-visualization of peripheral VV flow. Emergency cesarean hysterectomy was performed at 36 weeks. Histological findings showed missing decidua on the thin myometrium, which indicated placenta accreta spectrum, and massive perivillous fibrin deposition and increased numbers of syncytial knots in the placenta. We speculated that the thick placenta and peculiar VV flow profiles resulted from congestion of the intervillous space and intervillous underperfusion/low intraplacental oxygenation, respectively, resulting in FGR. Superb microvascular imaging is useful for diagnosing placenta accreta spectrum and understanding the pathophysiology of thick placenta and FGR.

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“…Additionally, slow blood flow in the intervillous space from the spiral artery is also visualized as a "scatter" that matches the heart rate of the mothers. In contrast, we previously demonstrated, in placenta increta, not only the thin myometrium with invasive placental tissue, but also the avascularity of the peripheral villous tree and congested stem vessels using SMI 2 .…”

Section: Introductionmentioning

confidence: 68%

Accuracy of antepartum ultrasound in evaluating placental pathology using superb microvascular imaging: main research article

Furuya¹,

Hasegawa²,

Doi³

et al. 2020

Preprint

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Objectives: To clarify whether microvascular ultrasound Doppler (SMI: superb microvascular imaging) can detect antenatal histological findings in pathologic placentas. Methods: In this prospective diagnostic observational study (STROBE), pregnant women who were admitted to our perinatal center for perinatal management were enrolled. Ultrasound examinations to identify placental pathologies using SMI were performed before delivery. After delivery, the placental tissue was clipped for microscopic examination, as the location of the placenta obtained ultrasound findings. The accuracy of antenatal ultrasound detection of placental pathologies was compared between women who were admitted due to fetal growth restriction (FGR), pre-eclampsia, and other indications. Results: The highest accuracy was observed with placental infarction in FGR (positive predictive value [PPV], 100%; sensitivity, 89%; area under the curve [AUC], 0.945), whereas PPV, sensitivity, and AUC in cases of preeclampsia were relatively low (AUC 0.540). Additionally, PPV, sensitivity, and AUC for avascular villi were 100%, 57%, and 0.785 in cases with FGR, 67%, 67%, and 0.780 in cases with preeclampsia, and 80%, 80%, and 0.920, respectively. The diagnostic accuracies predictive of congestion of stem villi and chorangiosis were insufficient (AUC<0.700). Conclusions: SMI can accurately detect placental pathologic findings, such as placental infarction and avascular villi. This modality may improve the perinatal management in cases of placental abnormalities.

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Diagnosis of placenta accreta spectrum using ultra‐high‐frequency probe and Superb Microvascular Imaging

Cited by 29 publications

References 7 publications

Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: A case described using superb microvascular imaging

Missing decidual Doppler signals as a new diagnostic criterion for placenta accreta spectrum: A case described using superb microvascular imaging

Peculiar blood flow profiles among placental chorionic villous vessels of an abnormally thick placenta in a case of systemic lupus erythematosus characterized using microvascular imaging

Accuracy of antepartum ultrasound in evaluating placental pathology using superb microvascular imaging: main research article

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