Pulsatile vessel at the posterior bladder wall: A new sonographic marker for placenta percreta

Abstract

Objective: We investigated using "pulsatile vessels at the posterior bladder wall" as a novel sonographic marker to demonstrate the severity of placenta accreta spectrum (PAS). Methods: This observational case-control study of 30 pregnant women was performed at Hackensack Meridian Health's Center for Abnormal Placentation in 2020. The case group was made up of women with historically described sonographic signs of PAS and was compared against two control groups: (1) women with uncomplicated placenta previa and (2) women with no evidence of placenta previa sonographically. All patients were evaluated with Color Flow Doppler ultrasound to assess the presence of arterial vessels at the posterior bladder wall. The flow characteristics and resistance indices (RI) were noted in the presence of pulsatile vessels. All patients' placentation was clinically confirmed at delivery. Patients with clinical invasive placentation underwent histopathological diagnosis to confirm disease presence. Results: Hundred percent of subjects in our series with suspected PAS exhibited pulsatile arterial vessels at the posterior bladder wall sonographically with a low RI of 0.38 AE 0.1 at an average of 24.6 AE 5.2 gestational weeks. Cases were histopathologically confirmed to have placenta percreta after delivery. Patients in either of the control groups did not display pulsatile vessels at the posterior bladder wall during antenatal sonographic evaluations and had no clinical evidence of PAS. Conclusion:The presence of posterior urinary bladder wall pulsatile arterial vessels with low RI, in addition to traditional sonographic markers increases the suspicion of severe PAS. Thus, these findings allow for the greater opportunity for coordination of patient care prior to delivery.

Modified Delphi study of ultrasound signs associated with placenta accreta spectrum

“…These comprised loss of the ‘clear zone’ (hypoechoic retroplacental zone), myometrial thinning, bladder‐wall interruption, presence of a placental bulge, uterovesical hypervascularity, placental lacunae and bridging vessels. None of the eight new signs identified in the present systematic review 14–28 reached a predefined consensus threshold as ultrasound findings that increase the probability of PAS at birth (Table 1). In addition, the panel was queried about second‐ or third‐trimester ultrasound findings that are not specific for PAS (i.e.…”

“…After exclusion of duplicates and two articles that were not available, 880 remained, of which a further 793 were excluded after screening the titles and abstracts, as the data they reported were not relevant. The remaining 87 studies were retrieved for full-text review, of which 72 were excluded after in-depth review, leaving 15 studies describing eight new ultrasound signs for the prenatal evaluation of PAS [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] . The process of selection of these articles is summarized in Figure S1, and the characteristics of the 15 studies identified by the systematic review are presented in Table S1.…”