Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance

Bhide, A.; Hussein, Ahmed M.; Elbarmelgy, Rasha A.; Thabet, Mohamed M.; Jauniaux, Eric

doi:10.1002/uog.26196

Cited by 6 publications

(4 citation statements)

References 26 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present data confirm and add to recently published data highlighting the role of imaging, both ultrasound [18][19][20][21] and magnetic resonance imaging [22][23][24] , in the preoperative evaluation of surgical outcome in patients with a high probability of PAS at birth. In particular, anomalies of the uteroplacental circulation i.e.…”

Section: Main Findingssupporting

confidence: 90%

“…However, the abnormal attachment of placental lobules to the uterine wall is a clinical diagnosis at birth and these ultrasound features are secondary to scarification and remodeling of the anterior LUS 1,13,20 and, thus, not specific to clinic-pathologic diagnosis of PAS 31 . Similarly, abnormalities of uteroplacental circulation, in particular, retroplacental hypervascularity, are not always specific of PAS, but when concomitant with the presence of placental lacunae 36 and anomalies of the uterine contour in patients with prior CD presenting with a low-lying placenta or placenta previa, increase the probability not only of PAS at birth 16 , but also the risk of intraoperative hemorrhage and peripartum hysterectomy [18][19][20][21] . The association of extended uterine dehiscence and thick adhesions between a highly vascularized LUS (Table 2) and the bladder serosa or the lateral pelvic vasculature make the access to the lower pelvis difficult and increases the risk of injury to the lower urinary tract, particularly in case of placental bulge.…”

Section: Future Perspectivesmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Hussein,

Thabet,

Elbarmelgy

et al. 2024

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

ObjectivesIntraoperative hemorraghe and peripartum hysterectomy are the main complications in patients presenting with a low‐lying or placenta previa undergoing repeat cesarean delivery. Patients with a high probability of placenta accreta spectrum (PAS) at birth also have a higher risk of intraoperative urologic injuries and the aim of this study was to evaluate the ultrasound signs and intraoperative features associated with these injuries.MethodsThis was a retrospective case–control study of consecutive singleton pregnancies included in a prospective cohort of patients with a history of at least one prior cesarean delivery (CD) and were diagnosed prenatally with an anterior low‐lying or placenta previa at 32‐36 weeks. All patients underwent investigational preoperative transabdominal and transvaginal ultrasound examinations within 48h prior to delivery. Ultrasound anomalies of uterine contour and utero‐placental vascularity and gross anomalies of the lower uterine segment (LUS) and surrounding pelvic tissue at delivery were recorded using a standardised protocol including the evaluation of the size of anomalies of uterine contour. The diagnosis of PAS was established when one or more placental lobule(s) could not be digitally separated from the uterine wall at delivery or during the gross examination of the hysterectomy or partial myometrial resection specimens, confirmed by histopathology. Data were compared between cases complicated by intraoperative urologic injuries and three controls from the same cohort matched by parity and the number of prior cesarean deliveries using conditional logistic regression.ResultsThere were 16 (9.4%) patients with an intraoperative bladder injury out of a cohort of 170 patients managed by the same multidisciplinary team during the study period. There were no patients diagnosed with ureteric or bladder trigone damage. Fourteen patients (87.5%) with a bladder injury had histopathologic evidence of PAS at birth including 11 (68.8%) cases described on microscopic examination as placenta increta and three as placenta creta. There was a significant (p= 0.03) difference between cases and controls in the distribution of the intraoperative LUS vascularity with the higher the number of enlarged vessels the higher the odds ratio (OR) of bladder injury. The multivariable regression analysis revealed that both gestational age and LUS remodelling on transabdominal ultrasound were associated with a bladder injury. A longer gestational age was associated with a lower risk of an injury. A higher LUS remodelling grade on TAS was associated with an increased risk of bladder injury. Patients with a grade of 3 (involving > 50% of the LUS) had odds of a bladder injury that were 9 times higher than for patients with a grade of 1 (involving < 30% of the LUS).ConclusionsPreoperative ultrasound examination is useful in the evaluation of the risk of the intraoperative bladder injury in patients with a history of prior CD presenting with a low‐lying or placenta previa. The larger the remodelling of the LUS on transabdominal ultrasound the higher the risk of adverse urologic events.This article is protected by copyright. All rights reserved.

show abstract

Section: Main Findingssupporting

confidence: 90%

Section: Future Perspectivesmentioning

confidence: 99%

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Hussein,

Thabet,

Elbarmelgy

et al. 2024

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

show abstract

“…The presence of placental lacunae in the second half of pregnancy has become synonymous with PAS 39 , and the number of lacunae is associated with the severity of PAS at birth (Figures 5 and 9) and surgical outcome 46,47 . Of the 11 standardized ultrasound signs associated with a high probability of PAS at birth, placental lacunae is the only sign to have been quantified successfully 39 .…”

Section: Clinical Outcome and Prognosismentioning

confidence: 99%

Placental lakes vs lacunae: spot the differences

Jauniaux,

Zosmer,

D'Antonio

et al. 2024

Ultrasound in Obstet & Gyne

Self Cite

View full text Add to dashboard Cite

Sonographic sonolucencies are anechoic areas surrounded by tissue of normal echogenicity commonly found in the placental parenchyma during the second and their trimesters of pregnancy. The ultrasound images of lakes and lacunae are generated by the low echogenicity of villous free areas within the placental parenchyma, filled with maternal blood of varying velocities. In normal placentation, lakes usually start appearing as soon as maternal blood starts flowing freely inside the intervillous space at the end of the first trimester whereas in accreta placentation lacunae develop progressively during the second trimester. Larger lakes are mainly found in area that have physiologically less villous tissue under the fetal plate or at both placental edges. Lakes can also be found in the centre of a lobule above the entry of a spiral artery and these lakes can transform into echogenic cystic lesion which have been associated with poor fetal growth. Lacunae are formed by the distortion of one or more placental lobule developing inside a uterine scar and are the consequence of high volume, high velocity flows from the radial/arcuate arteries and are associated with a high probability of PAS at birth. They often present with ultrasound signs of uterine remodelling following scarification. Lakes and lacunae can co‐exist in the same placenta and both will change in size and shape as pregnancy advances. The ultrasound images of lakes and lacunae are generated by the low echogenicity of villous free areas within the placental parenchyma, filled with maternal blood of varying velocities. Lakes of different sizes, positions and shapes are not of any clinical significance. There is a weak association between cystic lesions and placental malperfusion. By contrast, lacunae are secondary to the development of one or more placental lobules inside a uterine scar and are the main ultrasound marker of accreta placentation. Better understanding of the etiopathology of the development of placental sonolucent spaces and other associated morphological changes is necessary to identify patients at risk of subsequent complications during pregnancy and/or at delivery.This article is protected by copyright. All rights reserved.

show abstract

“…However, the patient needs to be informed that it may not be possible to conserve the uterus in the case of extended dehiscence of the LUS or if there is excessive bleeding during the dissection of the bladder-uterine interface. Within this context, ultrasound imaging can accurately identify abnormalities of uterine contour from the large area of dehiscence and increased pelvic vascularity 3,4 and it is essential to the preoperative evaluation of the surgical risks and patient counselling. 1…”

mentioning

confidence: 99%

Confirming the diagnosis of placenta accreta at birth: Intraoperative and macroscopic findings are essential but not histology

Hussein

Fox

Bhide

et al. 2023

BJOG

Self Cite

View full text Add to dashboard Cite

EDITORwith abnormality of the anterior aspect of the uterus, suggestive of PAS, even before establishing the definitive diagnosis.In summary, we believe that the authors' article makes a valuable contribution to the ongoing discussion around the diagnosis and management of PAS and UD. By highlighting the complexities of these conditions and the challenges of accurate diagnosis, the authors have opened up important avenues for further research and discussion.

show abstract

Assessment of ultrasound features of placenta accreta spectrum in women at high risk: association with outcome and interobserver concordance

Cited by 6 publications

References 26 publications

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Placental lakes vs lacunae: spot the differences

Confirming the diagnosis of placenta accreta at birth: Intraoperative and macroscopic findings are essential but not histology

Contact Info

Product

Resources

About