MRI of Placenta Accreta: A New Imaging Perspective

Derman, Anna; Nikac, Violeta; Haberman, Shoshana; Zelenko, Natalie; Opsha, Oleg; Flyer, Mark

doi:10.2214/ajr.10.5443

Cited by 136 publications

(125 citation statements)

References 20 publications

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“…En el segundo trimestre la placenta es homogéneamente ecogénica, con algunos septos delgados, adyacente a un miometrio hipoecogénico (3); hacia el tercer trimestre aparecen calcificaciones y lagos venosos con flujo laminar, dándole una apariencia heterogénea (3,14). La línea retro pla centaria (desidua) es regular e hipoecoica y presenta flujo sanguíneo de distribución paralela (11).…”

Section: Resultsunclassified

“…Actualmente, en pacientes con sospecha de AP se recomienda realizar primero el ultrasonido (US) transabdominal en escala de grises y con Doppler color, seguido por la resonancia magnética (RM) de pelvis en los casos en los que el ultrasonido no es concluyente o la evaluación de la placenta es limitada (14). Debido a que la incidencia del AP ha venido en aumento, el reto de los clínicos es identificar pacientes con factores de riesgo, realizar una evaluación prenatal precoz y determinar el manejo adecuado, con el fin de disminuir las tasas de morbimortalidad materno-fetal asociadas.…”

Section: Introductionunclassified

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Diagnóstico prenatal de acretismo placentario: hallazgos y utilidad del ultrasonido y la resonancia magnética. Reporte de casos en el Hospital Universitario de la Fundación Santa Fe de Bogotá (Colombia)

Wilches-Llanos¹,

Palazuelos-Jiménez²,

Trujillo-Calderón³

et al. 2014

Rev. Colomb. Obstet. Ginecol.

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Objetivo: describir y revisar los hallazgos relevantes en imágenes diagnósticas del abordaje prenatal de pacientes con diagnóstico de acretismo placentario. Materiales y métodos: presentamos los casos de tres mujeres que fueron atendidas en un centro hospitalario de alta complejidad, con factores de riesgo para acretismo placentario y evaluación prenatal por ultrasoni do (US) y resonancia magnética (RM), cuyo diagnóstico fue corroborado con estudio anatomopatológico. Se describen los aspectos clínicos, los hallazgos por imágenes y su correlación histológica. Se realizó una búsqueda de la literatura a través de PubMed, Lilacs y EBSCO, se incluyeron artículos originales, revisiones de tema y reportes de casos sobre la utilidad y los aspectos más importantes del US y la RM en el diagnóstico prenatal de acretismo placentario. Resultados: se incluyeron 11 artículos originales, 8 de revisión y 1 reporte caso. La placenta previa asociada a lagunas placentarias en ultrasonido y en RM a bandas hipointensas placentarias y el abombamiento del útero son considerados como los principales signos de acretismo. El US asociado a Doppler color tiene una sensibilidad de 97 % y una especificidad del 92 %. La RM puede definir el compromiso uterino y de los órganos vecinos, con una sensibilidad que varía entre el 77 y el 89,6 %, la especificidad es cercana al 92 %. Conclusiones: el abordaje prenatal precoz a través de las imágenes diagnósticas no invasivas brinda

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Section: Resultsunclassified

Section: Introductionunclassified

Diagnóstico prenatal de acretismo placentario: hallazgos y utilidad del ultrasonido y la resonancia magnética. Reporte de casos en el Hospital Universitario de la Fundación Santa Fe de Bogotá (Colombia)

Wilches-Llanos¹,

Palazuelos-Jiménez²,

Trujillo-Calderón³

et al. 2014

Rev. Colomb. Obstet. Ginecol.

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“…The advantage of prenatal diagnosis is to plan the delivery in a suitable center with a multidisciplinary team and adequate equipment and resources including a maternity-oriented intensive care unit (ICU) [12] [13]. Ultrasonographic features of placenta accreta include vascular spaces within the placenta, thinning of the myometrium overlying the placenta, loss of the retroplacental "clearspace", protrusion of the placenta into the bladder, increased vascularity of the uterine serosa and turbulent blood flow through the lacunae on doppler ultrasonography [13].…”

Section: Discussionmentioning

confidence: 99%

Conservative Management of Placenta Accreta of Seven Cases

Fakhir¹,

Zaki²,

Harou³

et al. 2018

OJOG

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Introduction: Placenta accreta is a potentially life threatening obstetrical condition. The incidence has increased. Diagnosis before delivery allows multidisciplinary planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Prenatal ultrasonography is used to support the diagnosis and guide clinical management leading probably to favorable outcomes. Actually a conservative option which includes leaving all or part of the placenta in situ when fertility preservation is desired is recommended.Methods: We retrospectively reviewed the medical records of all patients diagnosed with placenta accreta in gynecology-obstetrics department of the university hospital Mohammed the VI of Marrakesh; Morocco; from January the first 2014 to January the second 2016. Results: We found seven cases. We described: The epidemiological characteristics, risk factors, management of placenta accreta, outcomes and prognosis. The incidence of placenta accreta was 1/3847 deliveries. The mean term of delivery was 35 weeks. We have adopted a successful conservative treatment in six cases (71.4%). The radical treatment was adopted in one patient initially admitted for severe post-partum hemorrhage; the prognosis was good in 85.7% cases. Conclusion: Conservative management of placenta accreta is a safe and efficient and is an interesting alternative for hysterectomy.

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“…8 Antenatal diagnosis require imaging using Colour Doppler ultrasonography and MRI to predict the occurrence of placenta accreta in high risk patients.Ultrasonogram findings include loss of the normal hypoechoic myometrial zone,thinning or disruption of the hyperechoic interface between the uterine serosa and the bladder, intraplacental vascular lacunae and loss of normal venous flow pattern of the peripheral margin. 9 RCOG recommends routine USG scan of all patients at 20 -23 weeks to be specifically examined for placental localization, in which a low lying anterior placenta in patient with prior cesarean section should be meticulously followed up even in absence of haemorrhage. 10 Ultrasound is quiet accurate to predict severe placenta accreta in at risk patients,however, less severe cases may not have any ultrasound findings.…”

Section: Discussionmentioning

confidence: 99%

Per Operative Discovery of Placenta Percreta and Uterine Rupture at 37 Weeks of Gestation - A Case Report

Chowdhury

Feroz

2016

Bangladesh J Obstet Gynaecol

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The aim is to publish this case report of rarely occurring and life threatening condition, placenta percreta causing uterine rupture at 37 weeks of gestation. A second gravida with unevenful pregnancy was admitted in a tertiary hospital at her 37 weeks of gestation with lower abdominal pain and less foetal movement with history of one caesarean section.After admission she complaint of dull pain in whole abdomen which was gradually increasing in intensity, associated with hardening of uterus , initiallyher pulse and BP was stable,but later she had tachycardia and fetal heart rate was irregular.An emergency cesarean section was done. Immediately after opening the peritoneal cavity a perforation in uterine wall by placenta was found through which active bleeding was present.After holding the bleeding point,an incision in upper segment of uterine wall was given and an asphyxiated male baby was delivered by breech extraction. Then in presence of a senior gynaecologist caesarean hysterectomy was done keeping placenta in situ.Post operative period was uneventful for the mother but the baby was managed in neonatal care unit. Both of them were well during discharge. Placenta percreta is a rare pathological entity with challenging diagnostic and therapeutic requirement especially for resource limited settings.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 49-52

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MRI of Placenta Accreta: A New Imaging Perspective

Abstract: We found the most sensitive MR criteria for the diagnosis of invasive placentation to be abnormal placental vascularity in addition to the previously described intraplacental T2 dark bands.

Cited by 136 publications

References 20 publications

Diagnóstico prenatal de acretismo placentario: hallazgos y utilidad del ultrasonido y la resonancia magnética. Reporte de casos en el Hospital Universitario de la Fundación Santa Fe de Bogotá (Colombia)

Diagnóstico prenatal de acretismo placentario: hallazgos y utilidad del ultrasonido y la resonancia magnética. Reporte de casos en el Hospital Universitario de la Fundación Santa Fe de Bogotá (Colombia)

Conservative Management of Placenta Accreta of Seven Cases

Per Operative Discovery of Placenta Percreta and Uterine Rupture at 37 Weeks of Gestation - A Case Report

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