Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section

Abstract

A prospective evaluation for possible placenta accreta was performed in 34 patients with placenta previa and a history of one or more cesarean sections. Sonographic criteria used included (1) loss of the normal hypoechoic retroplacental myometrial zone, (2) thinning or disruption of the hyperechoic uterine serosa‐bladder interface, and (3) presence of focal exophytic masses. Of 18 patients with positive sonographic results, 14 had proof of placenta accreta and 16 of the patients underwent hysterectomy. Of 16 patients with negative sonographic results, only one had placenta accreta, and two patients required hysterectomy. Presence of numerous intraplacental vascular lacunae appears to be an additional risk criterion for placenta accreta, separate from the other criteria listed above.

Valor da ressonância magnética no diagnóstico antenatal do acretismo placentário

“…A ultra-sonografi a (US), o power doppler e a ressonância magnética (RM) têm sido utilizados como modalidades no diagnóstico do acretismo placentário, porém a US ainda é a modalidade mais acessível [1][2][3] Existem critérios ultra-sonográfi cos estabelecidos para o diagnóstico da placenta acreta, os quais têm sido utilizados com sucesso relativo. Entretanto, ainda não existem critérios para a RM 2,4 .…”

“…Entretanto, ainda não existem critérios para a RM 2,4 . A RM, nos últimos dez anos, se destaca como método de diagnóstico antenatal de malformações complexas e de patologias maternas na gestação, devido a não exposição à radiação ionizante e à boa resolução diagnóstica 5 .…”

“…Os critérios ultra-sonográfi cos indicativos de suspeita de acretismo placentário foram os preconizados na literatura, destacando-se: o adelgaçamento da zona hipoecóica retroplacentária, lacunas vasculares irregulares, irregularidade na espessura do miométrio basal e presença de vasos tortuosos invadindo o miométrio 2,3,6,7 . A análise das imagens foi realizada por dois radiologistas experientes em RM de abdome em consenso (SMG e JS).…”

Sonographic appearance of tornado blood flow in placenta previa accreta/increta

“…be diagnosed antenatally and the extent and location of placental invasion to be defined [1][2][3]5,6 . This allows the condition to be appropriately and electively managed and thus significantly reduces blood loss; this, in turn, potentially reduces the maternal morbidity and mortality associated with the surgical procedure in late pregnancy.…”

“…Her past obstetric history was significant for one Cesarean delivery and three uterine curettages for abortions. On gray-scale imaging, the presence of multiple large (the largest vascular channels measured 8.4 × 2.5 cm), irregular lacunar spaces within the placental parenchyma was noted and graded as a 3 + lacunar pattern 1 . Blood was observed to be moving in one of these huge venous lakes in a whorled manner with marked turbulent flow (> 16 cm /s) ( Figure 1) and tended to have a characteristic 'whooshing' sound when listened to with pulsed Doppler.…”