Uterine sparing approaches in management of placenta accreta: a summarized review

Placenta accreta is a potentially life-threatening obstetric condition that required multidisciplinary approach to management. Placenta accreta occurs in complete absence of the decidua basalis. Women with previous cesarean section delivery or placenta previa are known to be at greater risk of placenta accreta. A previous study reported that 24%& 67% increase in the incidence of placenta accreta in women 1 versus 3 or more previous cesarean deliveries respectively. Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. In practice, incomplete non-separation of the placenta at delivery leads to massive obstetric hemorrhage resulting in maternal morbidities such as massive blood transfusion, DIC, injury to the bladder and intestines and the need for hysterectomy. Sonographic examination with gray scale and color doppler imaging is the recommended first line modality for diagnosis of morbidly adherent placenta. Techniques developed for conservative management are techniques developed to preserve uterus and future fertility which is crucially linked to societal status and self-esteem.

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Efficacy of colour doppler imaging in prediction of placenta accrete

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174408 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4377

Author(s):

Rachna Agarwal ◽

Sruthi Bhaskaran ◽

Esha Gupta ◽

Dipanvita Dutta ◽

Anupama Tandon

Keyword(s):

Placenta Accreta ◽

Placenta Previa ◽

Color Doppler ◽

Color Doppler Imaging ◽

Final Diagnosis ◽

Doppler Imaging ◽

Colour Doppler ◽

Grey Scale ◽

Transfusion Requirements ◽

Caesarean Hysterectomy

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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P30.04: The role of ultrasonography and color Doppler imaging in antenatal diagnosis of placenta accreta in high-risk patients

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.8713 ◽

2010 ◽

Vol 36 (S1) ◽

pp. 283-284 ◽

Cited By ~ 1

Author(s):

O. Hoxhaj ◽

M. Gjoni ◽

M. Alushani ◽

T. Bare ◽

E. Dede ◽

...

Keyword(s):

High Risk ◽

Placenta Accreta ◽

Antenatal Diagnosis ◽

Color Doppler ◽

Color Doppler Imaging ◽

Doppler Imaging ◽

High Risk Patients ◽

Risk Patients

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Prenatal Diagnosis of Morbidly Adherent Placenta with 2D Ultrasonography, 3D Color Power Doppler and Magnetic Resonance Imaging

Donald School Journal of Ultrasound in Obstetrics & Gynecology ◽

10.5005/jp-journals-10009-1143 ◽

2010 ◽

Vol 4 (2) ◽

pp. 199-204

Author(s):

Sawsan Al Obaidly

Keyword(s):

Placenta Previa ◽

Color Doppler ◽

Power Doppler ◽

Color Doppler Imaging ◽

3D Ultrasound ◽

Massive Hemorrhage ◽

Uterine Wall ◽

Doppler Imaging ◽

Additional Information ◽

2D Ultrasound

Abstract The incidence of placenta accreta/percreta should rise steadily over the next century as the frequency of cesarean sections and advanced maternal age, both independent risk factors, increases. Patients who are at risk should be identified. The diagnosis of placenta previa accreta/percreta is possible by using gray-scale sonography, conventional color Doppler imaging and MRI through studying the relation of placenta to the uterine wall and nearby pelvic structures. The potentially new modality of 3D and 3D color power Doppler ultrasound has it's value as a tool to achieve significantly increased diagnostic accuracy in the prediction of massive hemorrhage by assessing the extent, location and quantification of abnormal uteroplacental neovascularization. Hence, 3D ultrasound has the potential for providing additional information over conventional 2D ultrasound studies in the diagnosis of placenta previa percreta. The diagnosis and anticipation of the problem achieve the best results for the obstetrician and the patient.

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