MRI is highly accurate in depicting placental extrauterine spread. The presence of abnormal vessels at the uterine serosa was the most important MRI feature for identifying invasive placenta. An abnormal vascular network within the vesicouterine space or parametrium was the most reliable MRI sign for detecting bladder or parametrial involvement.

Background Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type Prospective. Population One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence T2‐SSTSE (single‐shot turbo spin echo), T2‐TSE, T1‐TSEFS (TSE images with fat‐suppression) at 1.5T. Assessment Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5‐minute APGAR score <7. Statistical Tests Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi‐square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero‐placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5‐minute Apgar score (P = 0.078). Data Conclusion Preoperative identification of specific MRI features may predict peripartum course in high‐risk patients for PAS. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602–618.

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The objective of this work was to describe patient characteristics and the effect of vaginal hysterectomy in a University hospital in the last two decades. A retrospective review of women undergoing vaginal hysterectomy was performed. The type of hysterectomy and complications were determined. From 1974 to 1994, a total of 6420 hysterectomies were performed. The vaginal route was used for 1530 patients. In the last decade, the Heaney method was used. A comparison of the periods 1974-1984 and 1984-1994 revealed that with the Heaney technique, we had significantly fewer complications, including less febrile morbidity, bleeding requiring transfusion, and injuries. Vaginal hysterectomy, specially using the Heaney method, is a rewarding challenge for any gynecologic surgeon. There are a low postoperative morbidity rate and a low mortality rate, which is well below the average mortality rate associated with abdominal hysterectomy.

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The authors describe a new oncoplastic technique for lateral breast lumps. A double lateral submammary incision: elongated S (left) or Z (right) as half moon below and above the natural lateral submammary line allow a large excision of the lump and a reconstruction of the defect with two half flaps brought together in the middle. The complications of this procedure are very few and the cosmetic results are excellent.