The Value of Ultrasound and Magnetic Resonance Imaging in Diagnostics and Prediction of Morbidity in Cases of Placenta Previa with Abnormal Placentation

Abstract

SummaryBackgroundThe purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone.Material/MethodsThe study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients’ files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature.ResultsUS and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97–100% and 94–100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant.ConclusionsUS and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient’s morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI.

Diagnosis of abnormally invasive posterior placentation: the role of MR imaging

“…However, one of the studies stipulated that the experience and skill of the ultrasound operator, as well as the radiologist, can significantly affect the diagnostic outcomes of both modalities [10]. Although there may not be an overall difference in the sensitivity and specificity of the overall diagnosis, MRI may be superior in characterizing the degree of placental invasion [2].…”

Embolization of a life-threatening placenta increta hemorrhage with a four-month MRI follow-up

“…While US is still the diagnostic gold standard in the assessment of abnormal placentation, MRI has proved to be very useful in doubtful cases and to evaluate the degree of myometrial invasion of the placenta. Both imaging modalities are widely used as diagnostic tools in abnormal placentation and have comparable sensitivity in the diagnosis ( 2 – 4 ). However, only few studies describe the potential of MRI in the follow-up of conservatively treated cases with abnormal placentation so far.…”

“…Ultrasound (US) is the diagnostic gold standard for the assessment of abnormal placentation ( 2 , 3 ). However, in ambiguous US findings or suspicion of posterior placenta accreta, magnetic resonance imaging (MRI) has shown higher accuracy in the differentiation of the degree of placental invasion and provides information on the regional anastomotic vascular system ( 2 – 4 ).…”

A Marked Increase in Obstetric Hysterectomy for Placenta Accreta

“…As a result, ultrasonography and MRI made an exact antepartum diagnosis of placenta previa and accreta, which confirmed their important roles in the antenatal diagnosis. [ 16 17 ]…”