Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low‐lying placenta

Abstract

Objective To evaluate the diagnostic accuracy of a new ultrasound sign, intracervical lakes (ICL), in predicting the presence of placenta accreta spectrum (PAS) disorder and delivery outcome in patients with placenta previa or low‐lying placenta. Methods This was a retrospective multicenter study of women with placenta previa or low‐lying placenta at ≥ 26 weeks' gestation, who were referred to three Italian tertiary units from January 2015 to September 2018. The presence of ICL, defined as tortuous anechoic spaces within the cervix which appeared to be hypervascular on color Doppler, was evaluated on ultrasound images obtained at the time of referral. The primary aim was to explore the diagnostic accuracy of ICL in detecting the presence and depth of PAS disorder. The secondary aim was to explore the accuracy of this sign in predicting total estimated blood loss, antepartum bleeding, major postpartum hemorrhage at the time of Cesarean section and need for Cesarean hysterectomy. The diagnostic accuracy of ICL in combination with typical sonographic signs of PAS disorder, was assessed by computing summary estimates of sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and diagnostic odds ratios (DOR). Results A total of 332 women with placenta previa or low‐lying placenta were included in the analysis, with a median maternal age of 33.0 (interquartile range, 29.0–37.0) years. ICL were noted in 15.1% of patients. On logistic regression analysis, the presence of ICL was associated independently with major postpartum hemorrhage (odds ratio (OR), 3.3 (95% CI, 1.6–6.5); P < 0.001), Cesarean hysterectomy (OR, 7.0 (95% CI, 2.1–23.9); P < 0.001) and placenta percreta (OR, 2.8 (95% CI, 1.3–5.8); P ≤ 0.01), but not with the presence of any PAS disorder (OR, 1.6 (95% CI, 0.7–3.5); P = 0.2). Compared with the group of patients without ultrasound signs of PAS disorder, the presence of at least one typical sonographic sign of PAS disorder in combination with ICL had a DOR of 217.2 (95% CI, 27.7–1703.4; P < 0.001) for placenta percreta and of 687.4 (95% CI, 121.4–3893.0; P < 0.001) for Cesarean hysterectomy. Conclusion ICL may represent a marker of deep villus invasion in women with suspected PAS disorder on antenatal sonography and anticipate the occurrence of severe maternal morbidity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

USMRI Radiomics-based Model for Predicting the Degree of Placental Implantation and Develop Radiomics-based Prediction Models

“…Data collection: demographic features: age (21-48 years old, with an average of 28.6±6.5), gravidity, parity, history of abortion, history of cesarean section, placenta previa, history of placental implantation, and history of endometrial injury. Imaging ndings: MRI and ultrasound characteristics (the type of placenta previa, blurred boundary between the placenta and myometrium, blurred boundary between the uterine serosa and bladder, continuity of echoic line in the myometrium, abnormal retroplacental blood ow signals, signs of bladder involvement, and signs of cervical involvement) 6,11,12 .In this study, we obtained the informed consent of all patients were approved by the Human Ethics Committee of Xiangyang First People's Hospital a liated to Hubei Medical University (Issue No. S109…”

“…Depending on the depth of attachment and invasion into the myometrium of the uterus, placental implantation is divided into placenta accreta (PA), placenta increta (PI), and placenta percreta (PP)(Fig. 1-3) 3,6 . PA refers to the condition where the placental villi penetrate through the decidua and attach to the myometrium.…”

“…Placental implantation is usually diagnosed antepartum by ultrasound and MRI. It has been reported that the diagnostic sensitivity of ultrasound for placental implantation is 85% and the speci city is 76% 6,7 . However, ultrasound may not diagnose all cases of placental implantation due to sound attenuation and interference from the surrounding tissues.…”

“…MRI has the advantages of non-invasiveness, multiplanar reformation, high tissue resolution, and high sensitivity to blood ows. The diagnostic sensitivity is reported to be 92%, and the speci city 72% 5,6,8 . Therefore, MRI is more likely to accurately depict the depth of implantation, parauterine involvement, and cervical involvement.…”

Time to reconsider elective Cesarean birth

“…An antenatal screening program for AIP should involve identifying women at risk of AIP according to features in their medical history or findings in the current pregnancy, followed by ultrasound assessment to confirm or refute the diagnosis of AIP, with or without complementary magnetic resonance imaging to ascertain the degree of extrauterine involvement. Despite significant research contributions and recent clinical advances in the use of imaging to diagnose AIP [4][5][6] , a large proportion of cases often remain unidentified antenatally, presumably because effective screening strategies are lacking. We contest that a poor understanding of the pathophysiology of AIP underlies the absence of its effective prevention or screening.…”