Outcomes and Accuracy of 2D Gray-Scale Ultrasound Scan in Prenatal Diagnosis of Morbid Adherent Placenta
DOI:
https://doi.org/10.17140/GOROJ-2-114Keywords:
Outcomes, 2D gray-scale ultrasound, Morbid adherent placentaAbstract
Objective: This study designed to evaluate outcomes and accuracy of 2D gray-scale ultrasound scan in prenatal diagnosis of Morbid Adherent Placenta (MAP).
Patients and methods: Fifty pregnant women ≥28 weeks gestation with suspected MAP studied. 2D trans-abdominal gray-scale ultrasound scan done for studied women to confirm; placental location and findings suggestive of MAP. Intra-operative findings at delivery compared with pre-operative sonographer findings to evaluate outcomes and accuracy of 2D gray-scale ultrasound scan in prenatal diagnosis of MAP.
Results: 56%(28/50) of studied women had difficult placental separation, considerable intraoperative blood loss. Bilateral internal iliac artery ligation done to control bleeding in 28%(14/50), intrauterine compression balloon with placenta bed sutures done in 6%(3/50) and cesarean hysterectomy done in 22%(11/50) of studied women. Best 2D gray-scale ultrasound parameters for detection of difficult placental separation and considerable intraoperative blood loss in studied cases were; abnormal placental lacunae (73.9% sensitivity) and exophytic mass invading bladder (100% specificity & 100% PPV). Best 2D gray-scale ultrasound parameters for detection of emergency hysterectomy were; disruption of uterine serosa-bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% PPV and 84.1% NPV).
Conclusion: Antenatal diagnosis of MAP is crucial for; proper counseling for possible surgical complications, multidisciplinary team care and recruitment. Best 2D gray-scale ultrasound parameters for detection of difficult placental separation in studied cases were; exophytic mass invading bladder, while, best 2D gray-scale ultrasound parameters for detection of emergency hysterectomy were; disruption of uterine serosa-bladder interface and exophytic mass invading bladder.
References
ACOG Committee Opinion. Placenta accreta. No. 266. Amer-ican College of Obstetricians and Gynecologists. Obstet Gyne-col. 2002; 99: 169-170.
Abuhamad A. Morbidly adherent placenta. Seminars in Peri-natology. 2014; 37(5): 359-364.
Usta IM, Hobeika EM, AbuMusa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005; 193: 1045-1049. doi: 10.1016/j. ajog.2005.06.037
Silver RM. The MFMU cesarean section registry: maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107: 1226-1232.
Wortman AC, Alexander JM. Placenta accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2013; 40(1): 137-154. doi: 10.1016/j.ogc.2012.12.002
Rao KP, Belogolovkin V, Yankowitz J, Spinnato JA 2nd. Abnormal placentation: evidence-based diagnosis and man-agement of placenta previa, placenta accreta and vasa previa. Obstet Gynecol Surv. 2012; 67(8): 503-519. doi: 10.1097/ OGX.0b013e3182685870
Khong TY. The pathology of placenta accreta, a worldwide epidemic. J Clin Pathol. 2008; 61: 1243-1246. doi: 10.1136/ jcp.2008.055202
Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y. Placenta accreta: summary of 10 years: a survey of 310 cases. Placenta. 2002; 23: 210-214. doi: 10.1053/plac.2001.0764
Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous ce-sarean delivery and risks of placenta previa and placental abrup-tion. Obstet Gynecol. 2006; 107: 771-778.
Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006; 107(4): 927-941.
Eshkoli T, Weintraub AY, Sergienko R, Sheiner E. Placenta accreta: risk factors, perinatal outcomes and consequences for subsequent births. Am J Obstet Gynecol. 2013; 208(3): 219.e1-7. doi: 10.1016/j.ajog.2012.12.037
Chou MM, Ho ESC, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ul-trasound Obstet Gynecol. 2000; 15: 28-35. doi: 10.1046/j.1469- 0705.2000.00018.x
Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultra-sonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. 2006; 108: 573-581. doi: 10.1097/01.AOG.0000233155.62906.6d
Zhang L, Li P, He GL, et al. Value of prenatal diagnosis of placenta previa with placenta increta by trans-abdominal color Doppler ultrasound. Zhonghua Fu Chan Ke Za Zhi. 2006; 41: 799-802.
Dwyer BK, Belogolovkin V, Tran L, et al. Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med. 2008; 27: 1275-1281.
D’Antonio F, Bhide A. Ultrasound in placental disorders. Best Pract Res Clin Obstet Gynaecol. 2014; 28(3): 429-442. doi: 10.1016/j.bpobgyn.2014.01.001
Moodley J, Ngambu NF, Corr P. Imaging techniques to identify morbidly adherent placenta praevia: a prospec-tive study. J Obstet Gynaecol. 2004; 24(7): 742-744. doi: 10.1080/01443610400009402
Comstock CH, Lee W, Vettraino IM, Bronsteen RA. The early sonographic appearance of placenta accreta. J Ultrasound Med. 2003; 22: 19-23.
Al-Zirqi I, Stray-Pedersen B, Forsén L, Daltveit AK, Vangen S, NUR group. Validation study of uterine rupture registration in the Medical Birth Registry of Norway. Acta Obstet Gynecol Scand. 2013; 92(9): 1086-1093. doi: 10.1111/aogs.12148
Stafford I, Dildy GA, Clark SL, Belfort MA. Visually esti-mated and calculated blood loss in vaginal and cesarean delivery. Am J Obstet Gynecol. 2008; 199(5): 519.e1-7. doi: 10.1016/j. ajog.2008.04.049
Chou M, Chen WH, Tseng JJ, Chen YF, Yeh TT, Ho ESC. Prenatal detection of bladder wall involvement in invasive placentation with sequential two- Dimensional and adjunctive three-Dimensional Ultrasonography Taiwan. J Obstet Gynecol. 2009; 48(1): 38-45. doi: 10.1016/S1028-4559(09)60033-4
Comstock CH. Antenatal diagnosis of placenta accrete: a re-view. Ultrasound Obstet Gynecol. 2005; 26:89-96. doi: 10.1002/ uog.1926
Bencaiova G, Burkhardt T, Beinder E. Abnormal placental invasion experience at 1 center. J Reprod Med. 2007; 52(8): 709- 714.
Silver RM, Landon MB, Rouse DJ, et al. Maternal mor-bidity associated with multiple repeat cesarean deliveries. Obstet Gynecol. 2006; 107: 1226-1232. doi: 10.1097/01. AOG.0000219750.79480.84
Grobman WA, Gersnoviez R, Landon MB, et al. Pregnan-cy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol. 2007; 110: 1249-1255 doi: 10.1097/01.AOG.0000292082.80566.cd
Wright JD, Pri-Paz S, Herzog TJ, et al. Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gyne-col. 2011; 205 (1): 38.e1-6. doi: 10.1016/j.ajog.2011.01.040
Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand. 2011; 90(10): 1140-1146. doi: 10.1111/j.1600-0412.2011.01147.x
Guleria K, Gupta B, Agarwal S, Suneja A, Vaid N, Jain S. Abnormally invasive placenta: changing trends in diagnosis and management. Acta Obstet Gynecol Scand. 2013; 92(4): 461-464. doi: 10.1111/aogs.12083
Thia EW, Lee SL, Tan HK, Tan LK. Ultrasonographical fea-tures of morbidly-adherent placentas. Singapore Med J. 2007; 48(9): 799-802.
Warshak CR, Ramos GA, Eskander R, et al. Effect of pre-delivery diagnosis in 99 consecutive cases of placenta ac-creta. Obstet Gynecol. 2010; 115(1): 65-69. doi: 10.1097/ AOG.0b013e3181c4f12a
Chantraine F, Braun T, Gonser M, Henrich W, Tutschek B. Prenatal diagnosis of abnormally invasive placenta reduces ma-ternal peripartum hemorrhage and morbidity. Acta Obstet Gyne-col Scand. 2013; 92(4): 439-444. doi: 10.1111/aogs.12081
Eller AG, Porter TF, Soisson P, Silver RM. Optimal manage-ment strategies for placenta accreta. BJOG. 2009; 116(5): 648- 654. doi: 10.1111/j.1471-0528.2008.02037.x
Comstock CH, Love JJ Jr., Bronsteen RA, et al. sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol. 2004; 190: 1135-1140. doi: 10.1016/j.ajog.2003.11.024
Wong HS, Zuccollo J, Tait J, Pringle K. Antenatal topo-graphical assessment of placenta accreta with Ultrasound Aus-tralian and New Zealand. Journal of Obstetrics and Gynaecolo-gy. 2008; 48: 421-443. doi: 10.1111/j.1479-828X.2008.00891.x
Japaraj RP, Mimin TS, Mukudan K. Antenatal diagnosis of placenta previa accreta in patients with previous cesarean scar. J Obstet Gynaecol Res. 2007; 33(4): 431-437. doi: 10.1111/j.1447- 0756.2007.00549.x
Shi H, Pi P, Ding Y. Diagnosis of placenta previa accreta by two dimensional ultrasonography and color doppler in patients with cesarean section. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2012; 37(9): 939-943.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Gynecology and Obstetrics Research (GOR) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
