Evolving Cesarean Scar Pregnancy into Morbidity Adherent Placenta—Evidence from Serial Ultrasound Examination

Hsu, Chin-Chieh; Huang, Ko-En

doi:10.1016/j.jmu.2016.11.002

Cited by 5 publications

(3 citation statements)

References 4 publications

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“…The only possible justification of this may that in fresher scars the granulation tissue and scar itself may be a feasible or attractive site for MAP while the older scars may have changed physiologically so much that it would not favor the development of MAP and can be further examined. According to literature, the earliest gestation at which placenta accreta had been diagnosed by ultrasound was 9 weeks in a case of scar pregnancy [18][19][20] . Vijayasree M 2018 21 in the study, revealed sonography was only 33-percent sensitive for detecting placenta accrete.…”

Section: Resultsmentioning

confidence: 99%

Frequency of Morbidly Adherent Placenta in Previous Scar

2019

J Liaquat Uni Med Health Sci

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Jamshoro. A total of 205 patients with age women between 15 to 49 years, with having pregnancy of 04 to 36 weeks, alive singleton fetus, history of previous surgery like Caesarean Section, myomectomy, hysterotomy and associated placenta praevia were included. Patients with history of pelvic inflammatory disease (PID), dilatation and curettage (D&C) and intrauterine contraceptive device (IUCD) insertion, placenta abruption and primigravida were excluded. Mean+SD, frequencies & percentages were calculated. Chi-square test was used as a test of significance with a P value <0.05. RESULTS: Around 45.4% (n=93) women had scar due to previous caesarean section. Morbidly adherent placenta was found positive among 9.76% (n=20) women. Frequency of Placenta accreta vera was 1.5% (n = 3), Placenta increta was 6.76% (n = 14) and Placenta percreta was 1.5% (n=3). Stratified analysis found that risk of Morbidly adherent placenta (MAP) elevated with the increasing age, second trimester, high parity, having previous caesarean section & shorter the duration of scar. CONCLUSION: Morbidly adherent placenta is not a very uncommon condition. Its frequency is ten times more among women who had previous history of scar. Hence, the previous scared uterus and shorter duration increased further risk for all three types of morbidly adherent placenta.

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Section: Resultsmentioning

confidence: 99%

Frequency of Morbidly Adherent Placenta in Previous Scar

2019

J Liaquat Uni Med Health Sci

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“…No clear treatment guidelines have been suggested for the treatment of Morbidly Adherent Placenta. It has been shown that if cesarean scar pregnancy is complicated with morbidly adherent placenta (cesarean scar adherent placental tissue invasion), the most frequently therapeutic approach is hysterectomy [9].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Intramyometrial Placental Tissue Invasion in Cesarean Scar: A Case Report

Yan¹

2021

JBGSR

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Morbidly adherent placenta is one of the rare complications of Cesarean Section Pregnancy. This is the implantation (part or whole) of the placenta via the niche (dehiscence at the hysterotomy site) or scar of the prior cesarean section into the uterine wall. It is divided into placenta accreta, placenta increta or placenta percreta depending on the degree of placental tissue uterine invasion. It poses a high risk of maternal morbidity and mortality due to missed diagnosis and non-existence of clear treatment guidelines. We present a case of adherent placental tissue in cesarean scar pregnancy diagnosed with laparoscopy. We highlight the importance of early diagnosis and treatment of placental tissue uterine invasion in cesarean scar pregnancy.

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“…The main ultrasound signs highlighted, which are currently used by most authors in their specialty studies, are: the loss/ the interruption of the hypoechoic area at the level of the myometrium under the placental bed, placental gaps (large, irregular, transonic spaces that can present turbulent blood flow), the interruption of the hyperechoic line represented by the posterior vesical wall and the uterine serous membrane at this level, the thinning of the myometrium (reaching < 1mm), the presence of a exophytic area which exceeds the uterine serous membrane, infiltrating the urinary bladder. The echo Doppler images reveal: blood flow at the level of the placental gaps, most often exhibiting a turbulent character, the intense vascularization in the subplacental area and the hyper-vascularization of the vesicouterine interface (3,(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound signs in the diagnosis of placental anomalies: placenta accreta at the level of the uterine scar

Bălălău¹,

Pharmacy²,

Corbu³

et al. 2019

J Clin Invest Surg.

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Introduction. The incidence of Caesarian section has increased remarkably in recent years, which also leads to the increased maternal and fetal morbidity due to the complications that occur after the changes in the myometrial structure of the uterine scar. Placental anomalies with an increased risk for both the mother and the fetus are known under the heading of AIP (abnormally invasive placentation). Approximately 80% of the cases of placental anomalies are associated with a history of Caesarian delivery, curettage or myomectomies with the opening of the uterine cavity. Aims and scope. The present paper aims at highlighting the current techniques of diagnosing placental abnormalities from the first trimester of pregnancy. Several studies in the specialty literature have been evaluated, those published in the last 5 years (2015-2019) on the PubMed platform, the results being presented in the form of a review. Results. In 2018, Pagani et al. conducted a meta-analysis on 20 studies in the specialty literature. The current techniques used to diagnose placental abnormalities are abdominal and transvaginal ultrasound and Doppler ultrasound. A number of 7 studies (721 cases) used ultrasound to diagnose abnormalities. The identification of the degree of invasion was performed with a specificity of 97.1%-placenta accreta, 98.4%-placenta increta, 98.9%-placenta percreta and a sensitivity of 90.6%, 93% and 81.2% respectively. The main signs evidenced upon ultrasound, which are currently used by most authors in specialized studies are: the loss/ the interruption of the hypoechoic area at the level of the myometrium under the placental bed, placental gaps (which may exhibit turbulent blood flow), the interruption of the hyperechoic line represented by the posterior bladder wall and the uterine serous membrane at this level, the thinning of the myometrium (reaching < 1mm), the presence of an exophytic formation which exceeds the uterine serous membrane, infiltrating into the urinary bladder. The echo Doppler images reveal: blood flow at the level of the placental gaps, intense vascularization in the subplacental area and vesicouterine hyper-vascularization. In a paper published in 2018, Cali et al. highlighted the importance of identifying these ultrasound signs from the first trimester of pregnancy. The accuracy of diagnosing AIP in the first trimester is low compared to the 2 nd and 3 rd trimesters: the loss of the hypoechoic area 84.3% vs. 92.4%, the presence of placental gaps 78.3% vs. 100%, the interruption of the hyperechoic line at the level of the urinary bladder 75.9% vs. 93.3%, vesicouterine hyper-vascularization 50.6% vs. 81%. Conclusions. The importance of making an accurate diagnosis, as early as possible, of a placental anomaly is vital. The close monitoring of the pregnant woman, with serial ultrasounds performed quarterly, which should follow the signs indicated until so far in the specialized studies, as well as the preparation of a multidisciplinary operative team increases the probability of giving birth to...

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Evolving Cesarean Scar Pregnancy into Morbidity Adherent Placenta—Evidence from Serial Ultrasound Examination

Cited by 5 publications

References 4 publications

Frequency of Morbidly Adherent Placenta in Previous Scar

Frequency of Morbidly Adherent Placenta in Previous Scar

Diagnosis and Treatment of Intramyometrial Placental Tissue Invasion in Cesarean Scar: A Case Report

Ultrasound signs in the diagnosis of placental anomalies: placenta accreta at the level of the uterine scar

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