Lower uterine segment scar assessment at 11–14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery

Bhatia, Anju; Palacio, Montse; Wright, Ann; Yeo, G. S. H.

doi:10.1002/uog.23734

Cited by 6 publications

(4 citation statements)

References 38 publications

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“…Depending on local resources, this may be sought using transvaginal ultrasound at the time of the late first-trimester scan in women with prior Cesarean delivery. A finding of placental implantation over an exposed scar predicts the risk of PAS with an excellent negative predictive value 89 .…”

Section: Scar Pregnancy and Placental Abnormalitiesmentioning

confidence: 99%

“…performed at 11 + 0 to 14 + 0 weeks, and do not address the issue of very early scans. At 11 + 0 to 14 + 0 weeks, ultrasound signs suggestive of PAS disorders can be detected 84,[87][88][89][90] . Low anterior implantation of the placenta/gestational sac, next to or in the scar niche, is the most common early ultrasound sign associated with PAS disorders (Figure 3a).…”

Section: Scar Pregnancy and Placental Abnormalitiesmentioning

confidence: 99%

See 1 more Smart Citation

ISUOG Practice Guidelines (updated): performance of 11–14‐week ultrasound scan

Bilardo

Chaoui²,

Hyett

et al. 2023

Ultrasound in Obstet & Gyne

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ISUOG Practice Guidelines (updated): performance of 11-14-week ultrasound scan Clinical Standards CommitteeThe International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (

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Section: Scar Pregnancy and Placental Abnormalitiesmentioning

confidence: 99%

Section: Scar Pregnancy and Placental Abnormalitiesmentioning

confidence: 99%

ISUOG Practice Guidelines (updated): performance of 11–14‐week ultrasound scan

Bilardo

Chaoui²,

Hyett

et al. 2023

Ultrasound in Obstet & Gyne

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show abstract

“…Several authors advocate for first trimester transvaginal ultrasound screening for PAS with an experienced provider among those with prior caesarean delivery or uterine surgery and a low-lying placenta [58 ▪ ,59]. Furthermore, review of the first trimester ultrasound may be useful among women with a prior caesarean delivery and suspected PAS in the second/third trimester, when planning for delivery.…”

Section: Ultrasound Diagnosismentioning

confidence: 99%

Prenatal diagnosis of placenta accreta spectrum

Conturie

Lyell

2022

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of reviewPlacenta accreta spectrum (PAS) is a major cause of severe maternal morbidity. Perinatal outcomes are significantly improved when PAS is diagnosed prenatally. However, a large proportion of cases of PAS remain undiagnosed until delivery.Recent findingsThe prenatal diagnosis of PAS requires a high index of suspicion. The first step is identifying maternal risk factors. The most significant risk factor for PAS is the combination of a prior caesarean delivery and a placenta previa. Other major risk factors include a prior history of PAS, caesarean scar pregnancy (CSP), uterine artery embolization (UAE), intrauterine adhesions (Asherman syndrome) and endometrial ablation.Ultrasound is the preferred imaging modality for the prenatal diagnosis of PAS and can be highly accurate when performed by a provider with expertise. PAS can be diagnosed on ultrasound as early as the first trimester. MRI may be considered as an adjunct to ultrasound imaging but is not routinely recommended. Recent consensus guidelines outline the ultrasound and MRI markers of PAS.SummaryPatients with major risk factors for PAS warrant dedicated ultrasound imaging with a provider experienced in the prenatal diagnosis of PAS.

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“…The frequency of PASD has markedly increased over the last few years because of the increased Caesarean section rate. The risk is higher when placenta praevia complicates a pregnancy following previous CS, especially if the primary indication mandated a higher uterine scar and rises with each subsequent CS [ 6 ]. Historically treatment options centered round intentional retention of the placenta (IRP) with or without hysterectomy but latterly several techniques have been developed aimed at conserving the uterus including the Triple P [ 7 ] and Naussica [ 8 ] procedures.…”

Section: Introductionmentioning

confidence: 99%

Conservative surgical approach towards placenta accreta spectrum disorders for uterine preservation

Siraj

Tan

Wright

2023

BMC Pregnancy Childbirth

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Objective We previously described a technique for repair of the myometrial defect at repeat Caesarean section which increases residual myometrial thickness thereby potentially reducing future niche-related complications. Here we describe how this technique can be modified for use for placenta accreta spectrum disorders, in line with emerging evidence that this is more a disorder of myometrial deficiency than morbid adherence. Design The surgical performance of peripartum hysterectomy was compared with that of the modified technique in all women having repeat Caesarean delivery for placenta accreta spectrum disorder in a tertiary unit in Singapore between December 2019 and October 2021. Methods Modification of the original technique involved the systematic delivery of the placenta starting from its most posterior attachment after uterine exteriorization. This is followed by the identification, mobilization, and apposition of the boundaries of myometrial defects as described previously. Results Ten women had Caesarean hysterectomy and ten had Caesarean section using the modified approach. Age and gestational age at delivery were similar for the two groups. Women in the modified technique group had had fewer prior Caesarean sections and had a lower body mass index. Operating time, estimated blood loss and need for transfusion were all lower in the myometrial repair group but without statistical significance. There were no visceral injuries in the repair group but there was one bladder injury in the hysterectomy group. Conclusion The modified approach provides an effective alternative to peripartum hysterectomy with favourable surgical profile and allows uterine conservation with restoration of myometrial thickness.

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Lower uterine segment scar assessment at 11–14 weeks' gestation to screen for placenta accreta spectrum in women with prior Cesarean delivery

Cited by 6 publications

References 38 publications

ISUOG Practice Guidelines (updated): performance of 11–14‐week ultrasound scan

ISUOG Practice Guidelines (updated): performance of 11–14‐week ultrasound scan

Prenatal diagnosis of placenta accreta spectrum

Conservative surgical approach towards placenta accreta spectrum disorders for uterine preservation

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