Gray scale and Doppler ultrasound in placenta accreta: Optimization of ultrasound signs

Shawky, Mohamed; Abou-Bieh, Essam; Masood, Alaa

doi:10.1016/j.ejrnm.2016.04.010

Cited by 12 publications

(18 citation statements)

References 13 publications

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“…10 The lacunar grade is an important factor to predict peripartum complications in PAS. 9,27 Interruption of echogenic bladder line: the normal interface between the myometrium and urinary bladder is smooth and echogenic. In PAS, myometrial thinning results in the irregularity or disruption of this vesicouterine interface.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls

Gulati

Anand

Aggarwal

et al. 2021

Indian J Radiol Imaging

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Background Placenta accreta spectrum (PAS) is a significant cause of maternal and neonatal mortality and morbidity. Its prevalence has been rising considerably, primarily due to the increasing rate of primary and repeat cesarean sections. Accurate prenatal identification of PAS allows optimal management because the timing of delivery, availability of blood products, and recruitment of skilled anesthesia, and surgical team can be arranged in advance. Aims and Objectives This study aimed to (1) study the ultrasound and color Doppler features of PAS, (2) correlate imaging findings with clinical and per-operative/histopathological findings, and (3) evaluate the accuracy of ultrasound for the diagnosis of PAS in patients with previous cesarean section. Materials and Methods This prospective study was conducted in radiology department of a tertiary care hospital. After screening 1,200 pregnant patients, 50 patients of placenta previa with period of gestation ≥ 24 weeks and history of at least one prior cesarean section were included in the study. Following imaging features were evaluated: (1) gray scale covering intraplacental lacunae, disruption of uterovesical interface, myometrial thinning, loss of retroplacental clear space, and focal exophytic masses; and (2) color Doppler covering intraplacental lacunar flow, hypervascularity of uterine serosa–bladder wall interface, and perpendicular bridging vessels between placenta and myometrium. Study Design Present study is a prospective one in a tertiary care hospital. Results Of the 19 PAS cases, 18 were correctly diagnosed on ultrasonography (USG) and confirmed either by histopathological analysis of hysterectomy specimen or per-operatively due to difficulty in placental removal. PAS was correctly ruled out in 27 of 31 patients. The diagnostic accuracy of USG was 90%. The sensitivity, specificity, positive, and negative predictive values were 94.7, 87.1, 81.8, and 96.4%, respectively. Conclusion Ultrasound is indispensable for the evaluation of pregnant patients. It is an important tool for diagnosing PAS, thereby making the operating team more cautious and better equipped for difficult surgery and critical postoperative care. It can be relied upon as the sole modality to accurately rule out PAS in negative patients, thereby obviating unnecessary psychological stress among patients due to possible hysterectomy.

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Section: Discussionmentioning

confidence: 99%

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls

Gulati

Anand

Aggarwal

et al. 2021

Indian J Radiol Imaging

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“…7 Second and third trimester gray-scale sonographic characteristics include loss of continuity of the uterine wall, multiple vascular lacunae (irregular vascular spaces) within placenta, giving Swiss cheese appearance adjacent to the placental implantation site, lack of a hypoechoic border (myometrial zone) between the placenta and the myometrium, bulging of the placental/myometrial site into the bladder, and increased vasculature evident on color Doppler sonography. 8…”

Section: Introductionmentioning

confidence: 99%

Morbidly adherent placenta and it’s maternal and fetal outcome

Desai¹,

Jodha²,

Garg³

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Morbidly adherent placenta, a grave complication of pregnancy is becoming an emerging cause of increased maternal morbidity and mortality. Objectives of present study are to evaluate the etiopathogenesis of MAP, its clinical mode of presentation and maternal and fetal outcome with the aim to reduce maternal morbidity and mortality.Methods: It was a retrospective and prospective study at Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur in which data of patients with clinical diagnosis of MAP were reviewed from October 2014 to January 2016.Results: In this study of 10 cases of morbidly adherent placenta of Umaid hospital from October-2014 to January 2016 were studied, it was found that the mean age of presentation was 30.2 year. 60% cases were unbooked and 40% cases were booked with regular ANC visit. 60% cases presented with bleeding per vagina as a chief complaint and 30% cases were admitted for elective LSCS. 60% cases were already diagnosed case of placenta praevia. 90% cases had a history of previous LSCS. 80% cases were given BT intraoperatively and postoperatively. 60% cases underwent caesarean hysterectomy, 80% cases were shifted to ICU, and there was one maternal death.Conclusions: The incidence of MAP is increasing due to higher cesarean section (C/S) rate. Antenatal diagnosis via USG and color-doppler imaging, preoperative counseling, planning and multidisciplinary approach is necessary to reduce morbidity and mortality associated with MAP.

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“…The presence of placental lacunae (Figures 3 and 4), according to some authors, is the most valuable attribute of placenta increta, with the 89% sensibility, specificity of 81%, positive prognostic value of 73% and negative prognostic value of 93% [32], while the combination of lacunae and myometrium thickness below 1 mm in the retroplacental complex zone shows the metrics of 100, 72, 72 and 100% respectively [33]. Interruption of Pregnancy in Women with the Uterine Scar: Potential Risks DOI: http://dx.doi.org/10.5772/intechopen.86282…”

Section: Ultrasonographymentioning

confidence: 87%

Interruption of Pregnancy in Women with the Uterine Scar: Potential Risks

Dikke¹,

Ostromenskiy²

2020

Induced Abortion and Spontaneous Early Pregnancy Loss - Focus on Management

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objective: To assess the risks and identify effective and safe methods of abortion in women with uterine scar. Material: Literary sources published in the databases of Medline, PubMed, and others, of which 57 are included in this review. The main provisions: Termination of pregnancy in women with a scar on the uterus involves the use of any available method. For women with a scar on the uterus, it is necessary to prepare the cervix before a surgical abortion in all terms. Abnormal implantation of the embryo within the fibrous tissue of the scar after caesarean section can cause life-threatening bleeding of the mother during or after the termination of the pregnancy. Surgical excision of the affected area by hysteroscopic access, as well as transvaginal or transabdominal local administration of Methotrexate with or without an additional intramuscular dose of the same drug, seems to be optimal from the point of view of minimizing the frequency of complications. Conclusion: A scar on the uterus after caesarean section presents a high risk of abnormal attachment of the ovum and fatal bleeding during abortion.

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Gray scale and Doppler ultrasound in placenta accreta: Optimization of ultrasound signs

Cited by 12 publications

References 13 publications

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls

Ultrasound as a Sole Modality for Prenatal Diagnosis of Placenta Accreta Spectrum: Potentialities and Pitfalls

Morbidly adherent placenta and it’s maternal and fetal outcome

Interruption of Pregnancy in Women with the Uterine Scar: Potential Risks

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