Placenta accreta spectrum pas disorders have become a significant life threatening. Diagnostic accuracy of ultrasound and mri in the prenatal diagnosis of placenta accreta. Ultrasound and mri interests abidi h, armi s, abid c, achour a, boudaya f, chelly d first department of obstetrics and gynecology, maternity center rabta tunis, tunis, tunisia objective to list ultrasonography signs identified when a placenta accreta is suspected and to analyze the relevance of diagnosis with ultrasonography. Placenta accreta, abnormal adherence of the placenta to the wall of the uterus, so that it remains in the uterus after the baby has been delivered. Once rare, placenta accreta which includes accreta, increta, and percreta cases now occurs in 1 out of every 533 pregnancies, according to the american college of obstetricians and gynecologists. In general, no attempt is made to distinguish placenta accreta from placenta increta, because the treatment plan does not differ between the two. Placenta accreta or morbidly adherent placenta map is one of the most. Haste, true fisp help to minimize fetal and maternal motion artifacts. Placenta accreta occurs when the placenta becomes abnormally adherent to the myometrium rather than the uterine decidua. The value of specific mri features in the evaluation of suspected placental invasion. Magnetic resonance imaging of placenta accreta europe. Mri of placental adhesive disorder pubmed central pmc. Apr 14, 2014 purpose to evaluate the accuracy of ultrasonography and magnetic resonance imaging mri in the diagnosis of placenta accreta and to define the most relevant specific ultrasound and mri features that may predict placental invasion. Although uncommon, placenta accreta poses serious dangers to the mother.
Placenta accreta pa encompasses various types of abnormal placentation in which chorionic villi attach directly to or invade the myometrium. In the case of extensive placenta accreta, a csection followed by. Assessment of total placenta previa by magnetic resonance imaging and ultrasonography to detect placenta accreta and its variants. The usual outcome is an elective csection at around 38 weeks of pregnancy. The purpose of this paper is to describe the magnetic resonance imaging mr features of placenta accreta and percreta. The surgeon tends to treat more radically cases of placenta percreta with. Slices must be sufficient to cover the whole abdomen and pelvis from the diaphragm to pubic symphysis.
Ultrasound imaging of placenta accreta with mr correlation. Mri protocol is essentially based on threeplane t2 sequences for the. Although mri can be used to differentiate normal placenta from placenta accreta, diagnosing the depth of invasion is much more challenging. Magnetic resonance imaging may complement multimodal ultrasound in the diagnosis and staging of placenta accreta spectrum. Pa is a significant cause of maternal morbidity and mortality and is now the most common reason for emergent postpartum hysterectomy. Its prevalence has risen tenfold in the united states over the. The diagnosis of a pas is made on the basis of histopathologic examination and characterised by an absence of decidua and chorionic villi are seen to directly adjacent to myometrial. Management should take place in centers with special expertise. Twenty 20 women underwent mri because of suspicion of placenta accreta by ultrasonography. Pad is classified on the basis of the depth of myometrial invasion placenta accreta, placenta increta and placenta percreta.
Placenta accreta symptoms and risk factors bellybelly. This is largely because of the increasing number of cesarean deliveries, with up to onethird of all births now achieved via cesarean section 1, 2. If your health care provider suspects placenta accreta, he or she will work with you to develop a plan to safely deliver your baby. Slices must be sufficient to cover the whole abdomen and pelvis from the right to left.
On mri, hematomas have variable signal intensity, often with areas of t1 shortening present. Placenta accreta spectrum pas is a condition of abnormal placental invasion encompassing placenta accreta, increta, and percreta and is a major cause of severe maternal morbidity and mortality. Ucsf radiologists lead work on saresur joint consensus. If diagnosed in time, though, this condition doesnt mean you cant have a healthy baby. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Nov 15, 2018 placenta accreta is a serious, lifethreatening pregnancy complication that is on the rise worldwide, especially as cesarean sections have become increasingly common over the past few decades. Identify surgical list for case to be allocated to. However, with placenta percreta, invasion of the chorionic. If it is unrecognized before delivery, abnormal placentation can lead to catastrophic perinatal hemorrhage. Purpose to evaluate the accuracy of ultrasonography and magnetic resonance imaging mri in the diagnosis of placenta accreta and to define the most relevant specific ultrasound and mri features that may predict placental invasion. This book contains information obtained from authentic and highly regarded sources.
National accreta foundation minimize the risks of placenta. Its use must be recommended in the planning of any surgery of placenta percreta, being indispensable when a conservative uterine treatment is planned. While ultrasound is still the gold standard method of placental investigation, magnetic resonance imaging mri has certain benefits. Our ability to diagnose placenta accreta has changed over the last decade and, like most things in medicine, a high index of suspicion and experience has increased our chance to make a correct diagnosis. When a placenta accreta occurs on the posterior or lateral walls of the uterus, it may be difficult to detect by ultrasound. Mri is less reliable in differentiating between different degrees of placental invasion, especially between accreta vera and increta. Placenta accreta spectrum, formerly known as morbidly adherent placenta, refers to the range of pathologic adherence of the placenta, including placenta increta, placenta percreta, and placenta accreta. Our aim is to make a retrospective analysis of ultrasound findings of placenta accreta in women followed at our department. Placenta accreta video brigham and womens hospital duration. Sensitivity, specificity, positive predictive value and negative predictive value of ultrasound and.
This article focuses on the second, more specific definition. Placenta accreta medical specialties womens health. Dec 24, 2019 through an ultrasound or mri, your health care provider can evaluate how deeply the placenta is implanted in your uterine wall. The aim of this study was to evaluate the diagnostic value of ultrasound us as compared with magnetic resonance imaging mri in the detection of placenta accreta. Placenta accreta is a serious, lifethreatening pregnancy complication that is on the rise worldwide, especially as cesarean sections have become increasingly common over the past few decades. The best outcomes in placenta accreta are in prenatally diagnosed electively delivered cases. Accuracy of ultrasonography and magnetic resonance imaging in. Peker n, turan v, ergenoglu m, yeniel o, sever a, kazandi m, et al.
Where placenta accreta is present, the failure of the placenta to separate normally from the uterus after delivery is accompanied by severe postpartum hemorrhage. Pdiuc protocol for placental accreta full text view. Derman1 violeta nikac1 shoshana haberman2 natalie zelenko1 oleg opsha1. Pdiuc protocol for placental accreta pdiuc the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Normally these scans are 35 seconds which is a long time for a pregnant lady to hold hear breath. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. If complicated by coexisting placenta praevia development of the placenta in an abnormally low position near the cervix, severe bleeding before labour is common. The incidence of placenta accreta spectrum disorders is steadily rising in many countries, likely due. Once the diagnosis is suspected on ultrasound, mri can provide valuable. This irregularity is caused by abnormal bridging vasculature that is easily seen with doppler velocimetry. Magnetic resonance imaging for abnormally invasive placenta. Placenta accreta is the abnormal adherence of the placenta to the uterine wall. Placenta accreta can be successfully detected prenatally using ultrasound. Optimal management requires accurate prenatal diagnosis.
Matching between us and mri findings took place in 75% n 1520 of the negative cases and in 80% n 1215 of the positive cases of placenta accreta in the studied cohort. The mri images of 21 patients with a preliminary diagnosis of placental adhesive disorder scanned between 2005 and 2014 were evaluated. Mohammed abdalla egypt, domiat general hospital definition placenta accreta occurs when there is a defect of the decidua basalis, in conjunction with an imperfect development of the nitabuch membrane a fibrinoid layer that separates the decidua basalis from the placental villi. In many circumstances and within this protocol, the term placenta accreta is used to describe accretas, percretas and incretas interchangeably as a single disease spectrum. Magnetic resonance imaging, 1999, vol 17, pp 965971 6 lax a, prince m r. Even if the placenta is not the main point of evaluation, it is useful to understand the appearance of the placenta on obstetric imaging for other causes.
Mri protocol includes two different t2weighted sequences in axial, sagittal and. However, this can be a problem in that patients who have had a cesarean section often develop. Nov 01, 2008 magnetic resonance imaging in 300 cases of placenta accreta. An appropriate angle must be given in the axial plane perpendicular to the placenta. Diagnostic accuracy of ultrasound and mri in the prenatal. Placenta accreta is defined as abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall 1.
Magnetic resonance imaging in 300 cases of placenta accreta. Mri appearance of placenta percreta and placenta accreta. Warshak cr, eskander r, hull ad, scioscia al, mattrey rf, et al. In advanced gestational age, obese women, and posterior placental location, mri is advantageous due to the larger field of view and its multiplanar capabilities. Radiologists blinded to the final diagnosis evaluated six previously described mri findings of placenta adhesive disorder. Placenta accreta diagnosis and treatment mayo clinic. Finally, we illustrate how common pitfalls in mri interpretation can be avoided by careful adherence to the recommended image acquisition protocols and interpretation criteria. Magnetic resonance imaging of placenta accreta ncbi. Protocolbased interdisciplinary care from diagnosis to surgery will optimize both. Management of intractable haemorrhage associated with placenta accreta 41. Placenta accreta pa is a severe pregnancy complication which occurs when the chorionic villi cv invade the myometrium abnormally. Retrospective analysis of the ultrasound findings of placenta accreta in women followed between march 2009 and may 20.
Placenta praevia and prior caesarean section are the two important risk factors. Nov 30, 2015 diagnostic accuracy of ultrasound and mri in the prenatal diagnosis of placenta accreta. Up to 90% of accreta patients require a blood transfusion, with an average blood loss of 3000 to 5000ml. Some pathologies are seen more clearly in mri, such as infarctions and placental invasive disorders. Combining multiple image features can improve the accuracy of diagnosis for both ultrasound and mri. Original article ultrasound and mri accordance and. If complicated by coexisting placenta praevia development of the placenta in. If placenta accreta is diagnosed before the birth, then management can be carefully planned. Mri accurately predicted placenta accreta in six of 20 cases and correctly ruled out placenta accreta in 10 of 20 cases sensitivity 85. The frequency of placenta accreta has increased by more than 10fold in the past 30 years to approximately three cases per deliveries. The diagnosis is suspected via ultrasound or placenta mri, confirmed. An appropriate angle must be given in the coronal plane perpendicular across the placenta. Placenta accreta is both the general term applied to abnormal placental adherence and also the condition seen at the milder end of the spectrum of abnormal placental adherence.
Imaging protocols, normal placental appearance, elements for reporting, and diagnostic features of placenta accreta, placenta increta, and placenta percreta are discussed. This heterogeneity in protocol called for a need to establish uniform technique, lexicon. Placenta accrete, ultrasound, magnetic resonance imaging, image features introduction placenta accreta refers to the reduction or absence of the deciduas, which might result. The risk of complications from placenta accreta are lessened if the surgery is planned rather than performed in an emergency. Placenta accreta spectrum king edward memorial hospital. Mri findings associated with placenta accreta include dark t2 bands, bulging of the uterus, and loss of the dark t2 interface. This finding has long been documented in the sonographic literature and corresponds to the irregular placental venous lakes first mri of placenta accreta. Nov 21, 2010 its use must be recommended in the planning of any surgery of placenta percreta, being indispensable when a conservative uterine treatment is planned. Sep 06, 2017 pdiuc protocol for placental accreta pdiuc the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Check the positioning block in the other two planes. The antenatal diagnosis of placenta accreta ch comstock,a,b,c ra bronsteena a department of obstetrics and gynecology, william beaumont hospital, royal oak, mi, usa b department of obstetrics and gynecology, university of michigan, ann arbor, mi, usa c department of obstetrics and gynecology, wayne state university, detroit, mi, usa correspondence. Placenta accreta comprises a spectrum of disorders where all or part of the placenta becomes attached to the muscular wall of the uterus, which can result in lifethreatening hemorrhage at the time of delivery. Mri magnetic resonance imaging has also been used to diagnose placenta accreta. Protocolbased interdisciplinary care from diagnosis to surgery will optimize.
Magnetic resonance imaging may complement multimodal ultrasound in the diagnosis and. Mri of placenta accreta, placenta increta, and placenta percreta. In the case of placenta accreta, interruptions or bulging can occur and finberg and williams 14 found that this is a specific sign, but not a sensitive one, i. Placental attachment abnormalities, namely placenta accreta, include three. Listing a study does not mean it has been evaluated by the u. Ultrasonography usg and magnetic resonance imaging mri are. It is increasing in incidence because of increasing number of cesarean sections and is one of the main causes of excessive postpartum hemorrhage. The accuracy of sonography using gray scale and color doppler techniques for prenatal diagnosis of placenta accreta varies widely in different studies.
Figure 2 irregularity of uterinebladder interface arrows point to dotanddash appearance of echogenic uterinebladder interface. Placental abruption is a clinical diagnosis consisting of acuteonset vaginal bleeding, abdominal pain, uterine contraction and tenderness, and nonreassuring fetal heart tracings. Placental evaluation with mri radiology reference article. Mri is the preferred image modality for prenatal diagnosis of pad and as complementary technique when ultrasonography is inconclusive. Accuracy of ultrasonography and magnetic resonance imaging. Magnetic resonance imaging of placenta accreta epos. I am 34 wks with dc 4 3 prev cs with second pg i had placenta accreta confirmed by mri lost a lot of blood during delivery but they knew where the placenta had grown through so could cut in right place to avoid cutting right through it and making bleeding even worse. Placental evaluation with mri is a problemsolving technique that can be used if ultrasound evaluation is insufficient or confusing. Ultrasound had suggested truepositive diagnosis of accreta in 86. Mri of placenta accreta, placenta increta, and placenta. Radiologists blinded to the final diagnosis evaluated six previously described mri findings of placenta adhesive.
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