Placental Sonolucencies in the First Trimester

Baldassarre, Randall L.; Gabe, Michael; Pretorius, Dolores H.; Ramos, Gladys A.; Romine, Lorene E.; Hull, Andrew; Ballas, Jerasimos; Pettit, Katie

doi:10.1097/ruq.0000000000000171

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…A total of 876 articles were identified. After screening the abstracts, 51 full-text articles were assessed with respect to their eligibility for inclusion (Table S2) and seven studies were included in the systematic review ( Figure 1, Table 1) [35][36][37][38][39][40][41] . These seven studies included 551 pregnancies at high risk for AIP, of which 117 (21.2% (95% CI, 17.9-24.9%)) had AIP.…”

Section: Resultsmentioning

confidence: 99%

First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

D’Antonio

Timor‐Tritsch

Palacios‐Jaraquemada

et al. 2018

Ultrasound in Obstet & Gyne

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Section: Resultsmentioning

confidence: 99%

First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

D’Antonio

Timor‐Tritsch

Palacios‐Jaraquemada

et al. 2018

Ultrasound in Obstet & Gyne

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“…The occurrence of placental lakes at different timepoints during gestation has been associated with malperfusion-related pregnancy complications by several authors. Baldassarre et al 15 reported that the presence of placental lakes of ≥ 0.7 cm in diameter at 11-13 weeks of gestation is associated with higher incidence of placenta previa, marginal sinus (Figure 3b) and subchorionic hemorrhage compared with placental sonolucencies < 0.7 cm, but there was no difference in the rate of adverse obstetric outcome. Similarly, Thompson et al 11 and Reis et al 13 detected no association between the finding of placental lakes during the second or third trimester and uteroplacental complications or adverse pregnancy outcome.…”

Section: Clinical Outcomes and Prognosismentioning

confidence: 96%

“…They are often found in the center of a lobule or cotyledon, under the chorionic plate or in the marginal zone (Figure 1) from the end of the first trimester (Figure 2) and often contain turbulent, low-velocity flow. The reported prevalence in the general population varies from 2% to 71%, due to the use of different definitions and gestational ages at examination [13][14][15][16] . Their size, number and shape can also change with maternal position, uterine contractions, location of the placenta inside the uterine cavity and with direct pressure of the ultrasound probe 16 (Figure 1e).…”

Section: Ultrasound Morphologymentioning

confidence: 99%

“…Changes in the peripheral echogenicity of a lake have been associated with the development of intervillous thrombosis (Figure 4) and an increase in maternal serum alpha-fetoprotein level secondary to breakdown of the villous barrier 15,[18][19][20][21] . The ultrasound features of intervillous thrombosis change with advancing gestation as more fibrin is deposited in the lake periphery and depending on when or if the maternal blood clots in its center 3,21 .…”

Section: Ultrasound Morphologymentioning

confidence: 99%

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Placental lakes vs lacunae: spot the differences

Jauniaux,

Zosmer,

D'Antonio

et al. 2024

Ultrasound in Obstet & Gyne

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Sonographic sonolucencies are anechoic areas surrounded by tissue of normal echogenicity commonly found in the placental parenchyma during the second and their trimesters of pregnancy. The ultrasound images of lakes and lacunae are generated by the low echogenicity of villous free areas within the placental parenchyma, filled with maternal blood of varying velocities. In normal placentation, lakes usually start appearing as soon as maternal blood starts flowing freely inside the intervillous space at the end of the first trimester whereas in accreta placentation lacunae develop progressively during the second trimester. Larger lakes are mainly found in area that have physiologically less villous tissue under the fetal plate or at both placental edges. Lakes can also be found in the centre of a lobule above the entry of a spiral artery and these lakes can transform into echogenic cystic lesion which have been associated with poor fetal growth. Lacunae are formed by the distortion of one or more placental lobule developing inside a uterine scar and are the consequence of high volume, high velocity flows from the radial/arcuate arteries and are associated with a high probability of PAS at birth. They often present with ultrasound signs of uterine remodelling following scarification. Lakes and lacunae can co‐exist in the same placenta and both will change in size and shape as pregnancy advances. The ultrasound images of lakes and lacunae are generated by the low echogenicity of villous free areas within the placental parenchyma, filled with maternal blood of varying velocities. Lakes of different sizes, positions and shapes are not of any clinical significance. There is a weak association between cystic lesions and placental malperfusion. By contrast, lacunae are secondary to the development of one or more placental lobules inside a uterine scar and are the main ultrasound marker of accreta placentation. Better understanding of the etiopathology of the development of placental sonolucent spaces and other associated morphological changes is necessary to identify patients at risk of subsequent complications during pregnancy and/or at delivery.This article is protected by copyright. All rights reserved.

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“…Real‐time grayscale and color Doppler imaging in the late second and third trimesters are the recommended ultrasound (US) techniques to evaluate for PAS. Recently, attention has turned to first‐trimester evaluation, based on reports suggesting that findings of PAS can be identified earlier in gestation . An implantation of the gestational sac within or near a prior cesarean scar has been shown to be a precursor of PAS, and current opinions favor common pathophysiologic characteristics between PAS and the cesarean scar pregnancy (CSP) .…”

mentioning

confidence: 99%

Prospective First‐Trimester Ultrasound Imaging of Low Implantation and Placenta Accreta Spectrum

Happe

Rac

Moschos³

et al. 2020

J of Ultrasound Medicine

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Objectives-To prospectively evaluate low implantation of the gestational sac and other first-trimester ultrasound (US) parameters for prediction of placenta accreta spectrum (PAS). Methods-Women with a diagnosis of low implantation on clinically indicated first-trimester US underwent a transvaginal US examination at 10 to 13 weeks' gestation to assess the trophoblast location, anechoic areas, bridging vessels, and smallest myometrial thickness (SMT). The placental location was evaluated in the second trimester, and serial US examinations were performed in cases of low placentation. Placenta accreta spectrum was based on clinical findings and confirmed by histologic results. Results-Of 68 women, 40 (59%) had prior cesarean delivery (CD). Hysterectomy was performed in 8, all with prior CD. Of these, 7 (88%) had US suspicion of PAS. In 16 with prior CD and basalis overlying the internal os, 9 (56%) had second-trimester placenta previa, and 7 of 9 (78%) underwent hysterectomy with pathologic confirmation of PAS. Of 28 without prior CD, there were no cases of persistent low placentation in the third trimester regardless of the trophoblast location. Ultrasound parameters associated with PAS were a smaller distance from the inferior trophoblastic border to the external os, disruption of the bladder-serosal interface, bridging vessels, anechoic areas, and the SMT. In women with prior CD, use of the SMT in the sagittal plane yielded an area under the receiver operating characteristic curve of 0.96 (95% confidence interval, 0.91-1.00). Conclusions-First-trimester low implantation increases the risk of persistent placenta previa and PAS in women with prior CD. All parameters were associated with PAS, the most predictive being the SMT. Key Words-cesarean scar pregnancy; first-trimester ultrasound; low implantation; placenta accreta spectrum P lacenta accreta spectrum (PAS) is a life-threatening obstetric complication occurring when the placenta abnormally adheres to or invades the myometrium. Once rare, PAS now complicates as many as 1 per 300 pregnancies in the United States, with the substantial rise in the incidence paralleling the rise in cesarean delivery (CD) rates, a known risk factor for PAS. 1-3 When compared with intrapartum diagnosis, prenatal diagnosis of PAS improves maternal outcomes by allowing for multidisciplinary planning and delivery before the onset of labor, vaginal bleeding, or both, thus reducing maternal and fetal morbidity. 2,4-7

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Placental Sonolucencies in the First Trimester

Abstract: Placental sonolucencies detected on first-trimester screening sonograms in the general obstetric population are not predictive of poor obstetric outcomes.

Cited by 4 publications

References 17 publications

First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

First‐trimester detection of abnormally invasive placenta in high‐risk women: systematic review and meta‐analysis

Placental lakes vs lacunae: spot the differences

Prospective First‐Trimester Ultrasound Imaging of Low Implantation and Placenta Accreta Spectrum

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