Screening for morbidly adherent placenta in early pregnancy

Abstract

Accurate prediction of MAP can be achieved by ultrasound examination at 12-16 weeks' gestation. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Early first‐trimester transvaginal ultrasound is indicated in pregnancy after previous Cesarean delivery: should it be mandatory?

“…A recently published assessment of a two‐stage screening and diagnostic protocol for CSP also demonstrated high accuracy for sonographic prediction of PAS in the first trimester (false‐positive rate of 0.1%); in that study, all cases of PAS were associated, at the time of diagnostic assessment as early as 12 weeks in a PAS‐specialized clinic, with the sonographic features: intraplacental lacunae, retroplacental arterial‐trophoblastic blood flow and irregular placental vascularization on three‐dimensional power Doppler. These two studies describe ‘classic’ ultrasound findings identified in the late first to early second trimesters for accurately characterizing PAS.…”

“…However, several studies have illustrated that low anterior sac position within the niche (or on the hysterotomy scar), thin (or no) myometrial thickness, early appearance of placental lacunae and hypervascularity at the uterus–bladder interface are the most reliable sonographic features at 11–14 weeks associated with subsequent diagnosis of PAS. A recently published assessment of a two‐stage screening and diagnostic protocol for CSP also demonstrated high accuracy for sonographic prediction of PAS in the first trimester (false‐positive rate of 0.1%); in that study, all cases of PAS were associated, at the time of diagnostic assessment as early as 12 weeks in a PAS‐specialized clinic, with the sonographic features: intraplacental lacunae, retroplacental arterial‐trophoblastic blood flow and irregular placental vascularization on three‐dimensional power Doppler. These two studies describe ‘classic’ ultrasound findings identified in the late first to early second trimesters for accurately characterizing PAS.…”

Cesarean Scar Pregnancy Registry: an international research platform

“…Panaiotova et al . reported that accurate prediction of AIP can be achieved by assessment of the presence of six ultrasound markers, including intraplacental lacunar spaces and non‐visible CS scar, at 12–16 weeks' gestation. Therefore, screening for AIP in early pregnancy is recommended.…”

“…Ultrasound signs of AIP can also be used to describe CSP, as the two conditions share common histopathological features and CSP seems to be a precursor of AIP 15 (Figure 1). Panaiotova et al reported that accurate prediction of AIP can be achieved by assessment of the presence of six ultrasound markers, including intraplacental lacunar spaces and non-visible CS scar, at 12-16 weeks' gestation 16 . Therefore, screening for AIP in early pregnancy is recommended.…”

Diagnosis of placenta accreta spectrum using ultra‐high‐frequency probe and Superb Microvascular Imaging

“…High‐frequency transducers and SMI offer significant clinical benefits for obstetricians, allowing delineation of histological structures and hemodynamics of minute vessels of the placenta. Compared with conventional ultrasound, sonohistological evaluation using this high‐resolution probe has the potential to improve the accuracy of ultrasound evaluation of PAS and could facilitate its diagnosis at earlier gestations since it can depict small lesions. Accurate prenatal diagnosis of PAS and planned treatment in centers with surgical expertise should help improve the outcome of women with PAS.…”