Performance of antenatal imaging to predict placenta accreta spectrum degree of severity

Abstract

Introduction In cases of placenta accreta spectrum, a precise antenatal diagnosis of the suspected degree of invasion is essential for the planning of individual management strategies at delivery. The aim of this work was to evaluate the respective performances of ultrasonography and magnetic resonance imaging for the antenatal assessment of the severity of placenta accreta spectrum disorders included in the database. The secondary objective was to identify descriptors related to the severity of placenta accreta spectrum disorders. Material and methods All the cases included in the database for which antenatal imaging data were available were analyzed. The rates of occurrence of each ultrasound and magnetic resonance imaging descriptor were reported and compared between the Group “Accreta‐Increta” (FIGO grades 1 & 2) and the Group “Percreta” (FIGO grade 3). Results Antenatal imaging data were available for 347 women (347/442, 78.5%), of which 105 were included in the Group “Accreta – Increta” (105/347, 30.2%) and 213 (213/347, 61.4%) in the Group “Percreta”. Magnetic resonance imaging was performed in addition to ultrasound in 135 women (135/347, 38.9%). After adjustment for all ultrasound descriptors in multivariate analysis, only the presence of a bladder wall interruption was associated with a significant higher risk of percreta (Odds ratio 3.23, Confidence interval 1.33–7.79). No magnetic resonance imaging sign was significantly correlated with the degree of severity. Conclusions The performance of ultrasound and magnetic resonance imaging to discriminate mild from severe placenta accreta spectrum disorders is very poor. To date, the benefit of additional magnetic resonance imaging has not been demonstrated.

Predicting Placenta Accreta Spectrum Disorders in a Cohort of Pregnant Patients in the North-East Region of Romania—Diagnostic Accuracy of Ultrasound and Magnetic Resonance Imaging

“…Our results complement several other studies that reported bladder wall interruption and uterovesical interruption as predictors of a worse outcome in PAS patients [ 24 , 40 ]. In the case of MR imaging, similar percretization descriptors to those used in our study were associated with adverse events in several studies investigating PAS.…”

Searching for placenta percreta: a prospective cohort and systematic review of case reports

“…Furthermore, this can explain why the performance of ultrasound and magnetic resonance imaging to discriminate mild from severe PAS disorders remains poor. 87 Over 90% of cases of PAS are found in women with a prior CD presenting with a placenta previa. 65e67 However, cases of PAS have been described in primigravida women with no surgical history but presenting with a uterine pathology, such as a bicornuate uterus, adenomyosis, submucous fibroids, or myotonic dystrophy, 65 and as found in our systematic review, after radiotherapy.…”

A multicenter observational survey of management strategies in 442 pregnancies with suspected placenta accreta spectrum

“…In 385 women (87.1%) the diagnosis of PAS was made antenatally by ultrasound or MRI. Imaging details are published separately 17 . Imaging experts scored the likelihood that significant PAS was present at the time of imaging in 414 women (0 = unlikely, 10 = very likely) (Figure 2).…”

“…Expert antenatal imaging can accurately predict PAS. Despite expertise, minor forms of PAS are difficult to distinguish from severe PAS, leading to the possibility of false‐positive diagnoses 17 . The advantage of delivering in a referral center in these cases may be that conservative management can be offered more confidently, and hysterectomy can be avoided in false‐positive cases and, when necessary, may be completed with fewer complications.…”