Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas

Guy, Glenford P.; Peisner, David B.; Timor‐Tritsch, Ilan E.

doi:10.1016/0002-9378(90)91056-i

Cited by 97 publications

(46 citation statements)

References 14 publications

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“…10 These authors noted visible pulsatile flow in them and suggested that this implied transmission of high pulse pressure from the deep arterial system. Our study indicated that if the colour Doppler showed a diffuse lacunar flow pattern with high velocity pulsatile venous-type flow in the sonoluscent vascular spaces, there was a significant risk of life-threatening haemorrhagic complication.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of colour doppler imaging in prediction of placenta accrete

Agarwal

Bhaskaran

Gupta

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: In present scenario of increasing cases of previous caesarean section the diagnosis of Placenta accreta preoperatively is of great value to the attending obstetrician. This helps in preparing, counselling the patient and also in assembling a multidisciplinary team for effective peripartum clinical management of these patients to prevent maternal morbidity and mortality.Methods: One hundred patient with persistent placenta previa after 28 weeks gestation were screened by grey scale B mode sonography. In suspicious cases of placenta accreta, further assessment by colour Doppler ultrasound was done. The color doppler imaging (CDI) criteria used were - diffuse intra parenchymal placental lacunar flow, focal intra parenchymal placental lacunar flow, bladder-uterine serosa interphase hypervascularity, prominent sub-placental venous complex and loss of sub-placental vascular signal in areas lacking peripheral sub-placental hypoechoic zone. Patients were prospectively followed up till delivery and the CDI findings were analysed with reference to final diagnosis made during caesarean section.Results: Six of hundred patients exhibited characteristic CDI patterns highly specific for placenta accreta according to the criteria used. In all 6 patients, morbidly adherent placenta was present intraoperatively. The sensitivity and specificity of CDI in the diagnosis of placenta accreta in presentstudy was 100%. Caesarean hysterectomy was required in five patients. Patients with CDI features of lacunar flow had higher incidence of blood loss, transfusion requirements and need for caesarean hysterectomy compared to patients with nonlacunar flow. The remaining 94 patients with placenta previa, not suspicious for placenta accreta on sonography underwent uncomplicated caesarean section.Conclusions: The use of CDI along with conventional grey-scale sonography improves the diagnostic accuracy for prediction of placenta accreta in patients with persistent placenta previa.

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Section: Discussionmentioning

confidence: 99%

Efficacy of colour doppler imaging in prediction of placenta accrete

Agarwal

Bhaskaran

Gupta

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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“…The ultrasonographic findings of placenta accreta include vascular lacunae noted at the placental-myometrial junction in a 'Swiss Cheese' pattern, bladder-uterine serosa interphase hypervascularity, prominent subplacental venous complexes, and the absence of an echolucent area between the placenta and myometrium. 6,7 When color Doppler is used, efficacy of ultrasound to diagnose placenta accreta has been reported with 82% sensitivity, 97% specificity, 87% positive predictive value, and 95% negative predictive value. 8 As the placentation in classic placenta accreta may differ from the placentation in our case, the sonographic findings may be different from those described for placenta accreta.…”

Section: Discussionmentioning

confidence: 99%

“…Images of the placenta in our case did not display any lacunar spaces, obliteration of the echolucent region behind the placenta, abnormal placental vasculature, interruption of the bladder wall-uterine interface, or other sonographic findings described in the literature. 6 We hypothesize that this is because the placenta was globally adherent to an abnormal uterine lining. This may have limited focal placental invasion and similarly may have prevented the development of the classic ultrasound findings in placenta accreta.…”

Section: Discussionmentioning

confidence: 99%

Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation

et al. 2006

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Endometrial ablation has become a popular method of managing menorrhagia. Pregnancy after endometrial ablation has a high rate of complications. We present the case of a parous woman with a history of endometrial ablation with preterm premature rupture of membranes. Despite the absence of established sonographic markers for abnormal placentation, placenta accreta was noted at the time of cesarean delivery. In women with history of endometrial ablation, the endometrium is not normal and may allow for more aggressive placental invasion or adherence. Consequently, the sonographic indices described for evaluating placenta accreta may not be present. We believe that placentation in women with prior endometrial ablations should be considered extremely high risk for placenta accreta or increta and managed accordingly when preparing for delivery.

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“…be diagnosed antenatally and the extent and location of placental invasion to be defined [1][2][3]5,6 . This allows the condition to be appropriately and electively managed and thus significantly reduces blood loss; this, in turn, potentially reduces the maternal morbidity and mortality associated with the surgical procedure in late pregnancy.…”

Section: Picture Of the Monthmentioning

confidence: 99%

“…After careful counseling, the patient elected to terminate the pregnancy because of fear of significantly increased maternal mortality and morbidity as the pregnancy progressed. Massive blood loss was anticipated because antepartum color Doppler ultrasound revealed a diffuse lacunar flow pattern 2,3 . As the fetus was considered to be non-viable, prophylactic selective embolization of the anterior division of the hypogastric arteries was performed in the radiology department's angiography suite prior to Cesarean section in an attempt to reduce intraoperative blood loss 4 .…”

mentioning

confidence: 99%

Sonographic appearance of tornado blood flow in placenta previa accreta/increta

Chou

Tseng

Hwang

et al. 2001

Ultrasound in Obstet & Gyne

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A 27-year-old Taiwanese woman (gravida 6, para 2) was referred to our institution at 17 weeks' gestation with a presumptive diagnosis of placenta previa accreta. Her past obstetric history was significant for one Cesarean delivery and three uterine curettages for abortions. On gray-scale imaging, the presence of multiple large (the largest vascular channels measured 8.4 × 2.5 cm), irregular lacunar spaces within the placental parenchyma was noted and graded as a 3 + lacunar pattern 1 . Blood was observed to be moving in one of these huge venous lakes in a whorled manner with marked turbulent flow (> 16 cm /s) ( Figure 1) and tended to have a characteristic 'whooshing' sound when listened to with pulsed Doppler. Color Doppler ultrasound and power Doppler further defined this abnormal tornado pattern (Figure 2).Marked intraparenchymal placental vascular spaces seem to correlate with the depth of invasion and appear most often in cases of placenta percreta. Finberg and Williams 1 reported that of their four patients who had grade 3 + lacunar vascularity, three had placenta percreta. After careful counseling, the patient elected to terminate the pregnancy because of fear of significantly increased maternal mortality and morbidity as the pregnancy progressed. Massive blood loss was anticipated because antepartum color Doppler ultrasound revealed a diffuse lacunar flow pattern 2,3 . As the fetus was considered to be non-viable, prophylactic selective embolization of the anterior division of the hypogastric arteries was performed in the radiology department's angiography suite prior to Cesarean section in an attempt to reduce intraoperative blood loss 4 . Initially, small pieces (2 × 2 × 2 mm) of gelfoam absorbable gelatin sponge particles (Pharmacia and Upjohn, Kalamazoo, MI, USA) were used because of their temporary occlusion effect. However, although a large number of gelfoam pledgets were carefully injected, the hemostatic effect was unsatisfactory because of the high perfusion pressure due to extensive hypervascularity. Metallic coils (3 × 0.5 cm, Cook, Inc., Bloomington, IN, USA) were then injected which successfully occluded the bilateral anterior division of the hypogastric arteries. Immediately after arterial embolization, the patient was transferred to the operating room, and a non-viable fetus of 250 g was delivered through a high fundal vertical uterine incision. Elective hysterectomy was then performed. The estimated blood loss was 350 mL. Postoperative convalescence was satisfactory. A pathology study confirmed the diagnosis of placenta previa accreta/increta.The advent of obstetric ultrasound, color Doppler and power Doppler imaging has now enabled placenta previa accreta to

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Ultrasonographic evaluation of uteroplacental blood flow patterns of abnormally located and adherent placentas

Cited by 97 publications

References 14 publications

Efficacy of colour doppler imaging in prediction of placenta accrete

Efficacy of colour doppler imaging in prediction of placenta accrete

Premature rupture of membranes, placenta increta, and hysterectomy in a pregnancy following endometrial ablation

Sonographic appearance of tornado blood flow in placenta previa accreta/increta

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