Fazari’s Sign in Ultrasound Scan of Morbid Adherent Placenta/Placenta Accreta Spectrum (MAP/PAS) and Fazari’s Triad during (MAP/PAS) Surgery

Abstract

Morbid Adherent Placenta (MAP)/Placenta Accreta Spectrum (PAS) is a serious diagnosis which has a risk of complications. Ultrasound scan helps in early diagnosis and has great value in further confirmation and follow up. Observed new clinical sign and associated clinical triad are discussed here.

Outcomes of the Expectant Management of 10 Cesarean Scar Pregnancy Cases in Patients Who Refused the Termination of Pregnancy

“…In cases where doctors offer expectant management, we recommend a cesarean delivery between 34 and 35 weeks gestation for women with CSP. When MAP complicates CSP, the most common therapeutic approach is uterine removal, with the procedure ideally performed in a tertiary care unit by an experienced surgeon supported by senior anesthetists, urologists, and vascular surgeons, with immediate access to an ICU and blood bank services for blood transfusion and blood products [ 5 , 6 ].…”

“…We also performed major artery ligation in some cases. We used accurate surgical strategies and techniques involving meticulous adhesiolysis after the introduction of a neat dissection technique - Birds’ picking seeds’ technique [ 6 ] - as per prenatal USS vascular mapping to reduce obstetric hemorrhage.…”

“…Characteristic ultrasound findings of PAS include the absence of the retroplacental hypoechoic clear space, reduced uterine wall thickness, with myometrial thickness measuring less than 3 mm, and increased vascularity surrounding the myometrium. This can manifest as numerous large blood vessels and may lead to an irregular bladder wall with extensive associated vascularity [ 5 ].…”

“…Other findings include Fazari’s triad or Fazari’s sign (stair-stepped appearance). Several features characterize this sign, including the ballooning of the lower segment because of the presence of the entire placenta; a complete absence of the uterine wall, which is replaced by a vascular bed; and the placenta badly adhering to the urinary bladder, with penetration into the bladder space and its vasculature [ 5 , 6 ].…”

“…Bulging of the urinary bladder wall is also a characteristic ultrasound finding of PAS; it refers to the noticeable protrusion or swelling of the urinary bladder wall, often associated with the presence and infiltration of the placenta [ 5 , 6 ].…”