The “rail sign”: an ultrasound finding in placenta accreta spectrum indicating deep villous invasion and adverse outcomes

Shih, Jin-Chung; Kang, Jessica; Tsai, Shang‐Jie; Lee, Jen‐Kuang; Liu, Kao–Lang; Huang, Kuan-Ying

doi:10.1016/j.ajog.2021.03.018

Cited by 26 publications

(20 citation statements)

References 33 publications

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“…The association between endometriosis and an increased risk of placenta previa is robust [ 23 , 24 , 29 , 97 , 98 ]. Notably, placenta previa is the most significant risk factor for PASD [ 15 , 17 , 98 , 99 , 100 , 101 ]. Although our study identified that endometriosis is a risk factor for PASD, no studies have examined the influence of endometriosis on the rate of PASD after excluding the effect of the increased rate of placenta previa.…”

Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

et al. 2022

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This study aimed to assess the relationship between placenta accreta spectrum disorder (PASD) and endometriosis. The relationships among pregnancy, assisted reproductive technology (ART), placenta previa, ART-conceived pregnancy and PASD were also determined. A systematic literature review was conducted using multiple computerized databases. Forty-eight studies (1990–2021) met the inclusion criteria. According to the adjusted pooled analysis (n = 3), endometriosis was associated with an increased prevalence of PASD (adjusted odds ratio [OR] 3.39, 95% confidence interval [CI] 1.96–5.87). In the included studies, the ART rate ranged from 18.2% to 37.2% for women with endometriosis. According to the adjusted pooled analysis, women who used ART were more likely to have placenta previa (n = 13: adjusted OR 2.96, 95%CI, 2.43–3.60) and PASD (n = 4: adjusted OR 3.54, 95%CI 1.86–6.76) than those who did not use ART. According to the sensitivity analysis using an unadjusted analysis accounting for the type of ART, frozen embryo transfer (ET) was associated with an increased risk of PASD (n = 4: OR 2.79, 95%CI, 1.22−6.37) compared to fresh ET. Endometriosis may be associated with an increased rate of PASD. Women with placenta previa complicated with endometriosis who conceived using frozen ET may be a high risk for PASD.

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Section: Discussionmentioning

confidence: 99%

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

et al. 2022

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“…It is seen as two parallel running vessels in bladder mucosa and uterovesical junction with perpendicular bridging vessels in between them. 14 With the everincreasing number of CSs, the incidence of PAS has been rising at an alarming rate. In a study conducted by Shawky et al, there were 18 cases of PAS in a study population comprising 50 patients of PP with previous CS.…”

Section: Discussionmentioning

confidence: 99%

“…It is seen as two parallel running vessels in bladder mucosa and uterovesical junction with perpendicular bridging vessels in between them. 14 …”

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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“…The presence of ultrasound marker as the “rail sign”, which consists in two parallel neo vascularizations on color Doppler ultrasound, originating between the uterovesical junction and the bladder mucosa, is related with an increased risk of placenta increta or percreta. Therefore, higher risks of adverse clinical outcomes, such as hysterectomy, blood transfusion, admission to the intensive care unit and bladder invasion may occur [ 16 ]. Prenatal diagnosis is essential to prevent the morbidities associated with this pathology although two-thirds of patients do not have a correct diagnosis before delivery [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

“…Bilobed placenta is a placental morphological anomaly that refers to a placenta separated into two roughly equal-sized lobes, separated by membranes, and its incidence is around 2-8% of placentas [ 16 , 17 ]. The diagnosis is made via ultrasound assessment by the visualization of two separated placental discs of nearly equal size [ 16 , 17 ]. A succenturiate lobe is a smaller accessory placental lobe that develops in the membranes, apart from the main disc of the placenta.…”

Section: Resultsmentioning

confidence: 99%

Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound

et al. 2022

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The aim of this review is to present a wide spectrum of placental and umbilical cord pathologies affecting the pregnancy. Placental and umbilical cord anomalies are highly associated with high-risk pregnancies and may jeopardize fetal well-being in utero as well as causing a predisposition towards poor perinatal outcome with increased fetal and neonatal mortality and morbidity. The permanent, computerized perinatology databases of different international centers have been searched and investigated to fulfil the aim of this manuscript. An extended gallery of prenatal imaging with autopsy correlation in specific cases will help to provide readers with a useful iconographic tool and will assist with the understanding and definition of this critical obstetrical and perinatological issue.

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The “rail sign”: an ultrasound finding in placenta accreta spectrum indicating deep villous invasion and adverse outcomes

Cited by 26 publications

References 33 publications

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

Placenta Accreta Spectrum Disorder Complicated with Endometriosis: Systematic Review and Meta-Analysis

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

Placental and Umbilical Cord Anomalies Diagnosed by Two- and Three-Dimensional Ultrasound

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