Prenatal Diagnosis of Placenta Accreta

Abstract

Objective The purpose of this study was to compare the accuracy of transabdominal sonography and magnetic resonance imaging (MRI) for prenatal diagnosis of placenta accreta. Methods A historical cohort study was undertaken at 3 institutions identifying women at risk for placenta accreta who had undergone both sonography and MRI prenatally. Sonographic and MRI findings were compared with the final diagnosis as determined at delivery and by pathologic examination. Results Thirty-two patients who had both sonography and MRI prenatally to evaluate for placenta accreta were identified. Of these, 15 had confirmation of placenta accreta at delivery. Sonography correctly identified the presence of placenta accreta in 14 of 15 patients (93% sensitivity; 95% confidence interval [CI], 80%–100%) and the absence of placenta accreta in 12 of 17 patients (71% specificity; 95% CI, 49%–93%). Magnetic resonance imaging correctly identified the presence of placenta accreta in 12 of 15 patients (80% sensitivity; 95% CI, 60%–100%) and the absence of placenta accreta in 11 of 17 patients (65% specificity; 95% CI, 42%–88%). In 7 of 32 cases, sonography and MRI had discordant diagnoses: sonography was correct in 5 cases, and MRI was correct in 2. There was no statistical difference in sensitivity (P = .25) or specificity (P = .5) between sonography and MRI. Conclusions Both sonography and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. In the case of inconclusive findings with one imaging modality, the other modality may be useful for clarifying the diagnosis.

Abnormally invasive placenta: an overview of diagnosis and management options

“…Prenatal diagnosis is crucial in order to plan delivery and to reduce complication. 4 Management of AIP requires a multidisciplinary team approach. Surgical management strategies for AIP generally include the extirpative approach (attempt to remove placenta) CH and conservative management (with or without partial resection of placenta) Nevertheless, the best policy remains a matter of debate optimal timing of delivery remain controversial.…”

“…Prenatal ultrasonography (USG) is formerly considered as the routine diagnostic standard examination, but foetal MRI is emerging as an alternative and complimentary method. 4 The traditional approach to management has been entirely surgical namely en-bloc-hysterectomy with close physician support of circulatory indices, often in the intensive care unit. Maternal morbidity is known to be significant and cases of maternal mortality are very occasionally reported.…”

The Importance of a Late First Trimester Placental Sonogram in Patients at Risk of Abnormal Placentation

“…It occurs when there is abnormal adherence of the placenta to the uterine wall, involving a defect in the decidua basalis [1, 2]. The placenta invades the myometrium of the uterus (accreta), with more extensive invasion through the uterine serosa, ureters, bladder, and bowel in placenta percreta/increta [1, 3]. According to Miller et al [4], the most common abnormal attachment is placenta accreta.…”

“…Consequently, there is incomplete separation of the placenta from the uterus after delivery leading to significant postpartum hemorrhage [1, 2]. Placenta accreta is commonly treated by hysterectomy in order to avoid excessive hemorrhage and control the bleeding [1, 3]. …”

“…Obstetrical risk factors include placenta previa, prior uterine surgery, and previous Cesarean section [1, 3, 5]. The incidence of placenta accreta ranges from 1/2510 to 1/533 pregnancies with an iatrogenic rise noted in developing countries in parallel with rising Caesarean section rates [1, 2, 5–7].…”