Subgroup analysis of accreta, increta and percreta cases using acoustic radiation force impulse elastography

Abstract

Objective: To compare acoustic radiation force impulse (ARFI) elastography values and histopathological diagnoses (accreta, increta, percreta) in patients suspected of having abnormal placental invasion (API). Materials and methods: This prospective study included 54 patients in the third trimester with a history of caesarian section (CS) and API based on gray scale and Doppler ultrasonography (USG) and 35 healthy controls. Patients underwent ARFI elastography preoperatively. Elastography measurements of the fetal and maternal sides of the placenta were compared to histopathology. Results: Patients had higher maternal-side, fetal-side and average elastography values (P = 0.001). Intraoperatively, eight patients (14.8%) showed abnormal cervical canal invasion and 46 (85.2%) bladder and/or parametrial invasion. Eight patients underwent CS + placental-bed suture, 11 CS + excision of the lower segment, and 35 caesarean-hysterectomy. Histopathology of lower segment excision/caesarian-hysterectomy patients determined 10 (21.7%) accreta, 10 (21.7%) increta and 26 (56.6%) percreta cases. ARFI values were highest in the percreta subgroup. The increta subgroup showed higher ARFI values than the accreta subgroup but maternal-side, fetal-side and average ARFI values were not significantly different across the subgroups (P > 0.05). The cut-off values for average, peripheral and central elastography were determined as >0.90, >0.76, >0.98 (m/s) with sensitivities of 98, 64, 98% and specificities of 85, 80, 91%, respectively. Conclusion: ARFI elastography can detect API. However, it cannot determine invasion depth reliably. More studies with subgroup analyses are warranted to reveal its usefulness for invasion depth.

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.…”

Elevated serum YKL-40 levels as a diagnostic and prognostic marker in the placenta accreta spectrum

“…Although ultrasonography is an effective method for showing abnormal placental invasion, it does not provide sufficient information about the depth of invasion. Therefore, it is difficult to determine the abnormal invasion of the accreta, increta, and percreta groups by USG ( 15 ) .…”

Can placental elasticity predict the time of delivery in cases of threatened preterm labor?

“…Ultrasound elastography has been recently used in the obstetrics and gynecology field. Pregnant women with complications including IUGR, 12 preeclampsia, 15 cholestasis of pregnancy, 16 mild variations (single umbilical artery) in fetuses 17 and placental invasion anomalies 18 have been evaluated via placental elastography in recent studies. It has also been shown that there is a negative impact of obesity on placental tissue structure 19 .…”