Screening for placenta accreta at 11-14 weeks of gestation

Stirnemann, J.; Mousty, E.; Chalouhi, G. E.; Salomon, Laurent; Bernard, Jean‐Pierre; Ville, Y.

doi:10.1016/j.ajog.2011.07.021

Cited by 49 publications

(47 citation statements)

References 43 publications

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“…At this point, introduction of early first-trimester (5-8 weeks) diagnosis by transvaginal sonography in all patients with pregnancies after cesarean deliveries seems to be the logical path. 36,37 Although most obstetricians and gynecologists in the United States will advocate for first-trimester sonography in all patients, its routine introduction must await prospective studies proving its utility. Without waiting for the above to happen, we introduced this practice in our offices.…”

Section: Discussionmentioning

confidence: 99%

Cesarean Scar Pregnancies

Timor‐Tritsch

Khatib

Monteagudo

et al. 2015

J of Ultrasound Medicine

124

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Objectives To evaluate the management, clinical courses, and outcomes of cesarean scar pregnancies diagnosed in the first trimester. Methods We identified 60 cases of cesarean scar pregnancies diagnosed between 5 and 14 weeks. Group A contained 48 patients with fetal/embryonic cardiac activity; group B comprised 12 patients without cardiac activity; and group C included 11 patients with cardiac activity who chose expectant management. Results Five of the 48 patients (10.4%) in group A were successfully treated for vaginal bleeding. Thirty‐three (68.7%) received methotrexate injections, and all had full resolution. Three (6.3%) required uterine artery embolization for late‐developing arteriovenous malformations. Ten of the 12 patients (83.3%) in group B were managed expectantly and had full recovery. Two of the 10 (20.0%) had arteriovenous malformations; 1 had unsuccessful uterine artery embolization followed by a hysterectomy, and the second requested a hysterectomy. Ten of the 11 patients (90.9%) in group C continued the pregnancies. One declined local injection. Four of the 10 (40.0%) delivered live offspring by successive elective cesarean deliveries. Three (30.0%) had hysterectomies for placenta percreta, and 1 did not have a hysterectomy after delivery. Five (50%) had second‐trimester complications, all leading to hysterectomies. Of the 60 patients, 20 (33.3%) had serious complications: 5 had arteriovenous malformations; 4 had uterine artery embolization; and 11 had hysterectomies. Conclusions A cesarean scar pregnancy is a serious complication for patients who have had cesarean deliveries. Counseling, treatment, and follow‐up are challenging for patients and caregivers. However, emerging data from different management approaches confirm that a cesarean scar pregnancy may progress and result in a live neonate at the expense of further fertility. This study confirmed that expectant management of a cesarean scar pregnancy is associated with a high risk of hysterectomy due to morbidly adherent placenta.

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Section: Discussionmentioning

confidence: 99%

Cesarean Scar Pregnancies

Timor‐Tritsch

Khatib

Monteagudo

et al. 2015

J of Ultrasound Medicine

124

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“…With increasing utilization of first trimester screening ultrasonography, detection of abnormal placentation early in pregnancy has increased. Ultrasonic markers identified early in gestation include low implantation [6,7], hypoechoic defects, subjective interpretation of thinning, and invasion into adjacent structures [7,8]. Other first trimester sonographic observations seen with abnormal placentation include those which are more commonly seen at more advanced gestational ages such as an irregular myometrial-placental interface, vascular lacunae, and persistent previa [9,10].…”

Section: Discussionmentioning

confidence: 99%

Placenta Percreta with Occult Uterine Rupture in the First Trimester

Singh¹,

Jodicke²,

Reynolds³

et al. 2016

JCR

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Abstract:Placenta percreta is a rare finding in the first trimester and is often associated with severe maternal morbidity. Herein we describe a case of placenta percreta with occult uterine rupture in the first trimester in a patient with a history of two previous cesarean deliveries. Imaging was concerning for placenta accreta. Following onset of acute abdominal pain, she underwent exploratory laparoscopy, which was negative for overt uterine scar dehiscence. She ultimately underwent total abdominal hysterectomy at 14 weeks following severe bleeding, with intraoperative and histologic findings consistent with placenta percreta with dehiscence of the anterior lower uterine segment below the level of, and obscured by the vesicouterine peritoneum.Bleeding and severe abdominal pain in the first trimester in the context of prior uterine instrumentation should always prompt evaluation of the scar, by imaging in a stable patient, and by direct visualization if necessitated. However, maintenance of clinical suspicion for uterine scar dehiscence is warranted in patients at high risk even in the absence of direct visualization intra-operatively.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…Placenta increta (invasion deeper into the myometrium) represents 18% of cases, and placenta percreta (invasion all the way through the uterus and into surrounding structures) represents 7% of cases. 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].…”

Section: Introductionmentioning

confidence: 99%

“…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]. Current research suggests a 25%–50% incidence of placenta accreta in patients with a placenta previa and prior Cesarean delivery [4].…”

Section: Introductionmentioning

confidence: 99%

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

Moretti

Merziotis

Ferraro

et al. 2014

Case Reports in Obstetrics and Gynecology

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Background. Placenta accreta is a potentially life-threatening obstetrical condition and is responsible for many emergency Caesarean hysterectomies. Early prenatal diagnosis may help minimize maternal morbidity and mortality. This report highlights risk factors, early diagnostic findings and complications associated with placenta accreta, and the role of first trimester sonography in diagnosis. Case. A 38-year-old pregnant woman, G2P1L1 with history of one previous Caesarean section, presented with vaginal bleeding at 13 weeks' gestation. Ultrasound examination was highly suspicious of placenta previa with accreta. During an earlier 12-week scan for nuchal translucency measurement, the placenta was suboptimally visualized. She was counselled regarding potential maternal and fetal complications as well as management options. At 33 weeks' gestation Caesarean hysterectomy was performed due to vaginal bleeding. Conclusion. Early ultrasound screening in high-risk patients may be advantageous in order to identify placenta accreta and conduct appropriate patient counseling regarding risks and management options.

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Screening for placenta accreta at 11-14 weeks of gestation

Cited by 49 publications

References 43 publications

Cesarean Scar Pregnancies

Cesarean Scar Pregnancies

Placenta Percreta with Occult Uterine Rupture in the First Trimester

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

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