Role of Sonography in Prenatal Evaluation of Placenta Accreta
Keywords:
Placenta accreta, Sonography, Color Doppler, Sensitivity, SpecificityAbstract
Objective: To evaluate the diagnostic accuracy of gray scale and doppler examination in antenatal diagnosis of placenta accreta.
Materials and Methods: This is a prospective study done in a tertiary care center having large number of obstetrical cases,Ziauddin University hospital during a period of ten months from 12th August 2014 to 11th June 2015.Thirty seven pregnant high risk cases all with clinical suspicion of placenta accreta were subjected to sonographic evaluation using gray scale and color doppler imaging by senior radiologists. Presence of vascular lacunae with turbulent flow, loss of retro-placental clear space, vessels traversing the uterine serosa, thin out myometrium and interrupted retro-placental flow was evaluated sonographically. Maternal delivery records were reviewed for delivery outcomes and sonographic findings were confirmed at delivery on surgical and clinical findings.
Results: The diagnostic sensitivity of ultrasound for placenta accreta was 93.3% and specificity was 85.7%. Positive predictive value was 96.5% whereas negative predictive value of 75%.
Conclusion: Gray scale and color Doppler sonography has fairly good sensitivity for prenatal diagnosis of placenta accreta
References
Miller DA, Chollet JA, Goodwin TM. Clinical risk fac-
tors for placenta previa-placenta accreta. Am JObstetGyn-
ecol 1997;177:210-14
ACOG Committee on Obstetric Practice. ACOGCommit-
tee opinion no. 266, January 2002: placenta accreta.
ObstetGynecol 2002;99:169-70
Silver RM, Landon MB, Rouse DJ. Maternal morbidity
associated with multiple repeat cesarean deliveries.
ObstetGynecol 2006;107:1226-32
Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar
AH. Placenta previa-accreta: risk factors and complicat-
ions. Am J Obstet Gynecol 2005;193:1045-9
Wehrum MJ, Buhimschi IA, Salafia C. Accreta complica-
ting complete placenta previa is characterized by reduced
systemic levels of vascular endothelial growth factor
and by epithelial-to-mesenchymal transition of the inv-
asive trophoblast. Am J ObstetGynecol2011; 204:411.e1-
e11
Tantbirojn P, Crum CP, Parast MM. Pathophysiology of
placenta accreta: the role of deciduas and extravilloustro-
phoblast. Placenta 2008;29:639-45
Strickland S, Richards WG. Invasion of the trophoblast.
Cell 1992;71:355-7
Lam G, Kuller J, McMahon M. Use of magnetic resona-
nce imaging and ultrasound in the antenatal diagnosis
of placenta accreta. J SocGynecolInvestig 2002;9:37-40
Finberg HJ, Williams JW. Placenta accreta: prospective
diagnosis in patients with placenta previa and prior
cesarean section. J Ultrasound Med 1992;11:333-43
Levine D, Hulka CA, Ludmir J, Li W, Edelman RR.
Placenta accreta: evaluation with color Doppler US,
power Doppler US, and MR imaging. Radiology 1997;
:773-6
Chou MM, Tseng JJ, Ho ESC. Prenatal diagnosis of
placenta previaaccreta by transabdominal color Doppler
ultrasound. Ultrasound Obstet Gynecol 2000;15:28-35
Comstock CH, Love JJ Jr, Bronsteen RA. Sonographic
detection of placenta accreta in the second and third
trimesters of pregnancy. Am J Obstet Gynecol 2004;190:
-40
Wong HS, Zucollo J, Parker S, Burns K, Tait J, Pringle
KC. Antenatal diagnosis of non-previa placenta increta
with histological confirmation. Ultrasound Obstet Gyne-
col 2006;27:467-9
Japaraj RP, Mimin TS, Makudan K. Antenatal diagnosis
of placenta previaaccreta in patients with previous ces-
arean scar. J Obstet Gynecol 2007;33(4):431-7
Dwyer BK, Belogolovkin V, Tran L. Prenatal diagnosis
of placenta accreta: sonography or magnetic resonance
imaging? J Ultrasound Med 2008; 27:1275-81
Esakoff TF, Sparks TN, Kaimal AJ. Diagnosis and morbi-
dity of placenta accreta. Ultrasound ObstetGynecol2011;
:324-7
Shih JC, Palacios Jaraquemada JM, Su YN. Role of
three-dimensional power Doppler in the antenatal diag-
nosis of placenta accreta: comparison with gray-scale
and color Doppler techniques. Ultrasound Obstet Gyne-
col2009; 33:193-203
Warshak CR, Eskander R, Hull AD. Accuracy of ultra-
sonography and magnetic resonance imaging in the dia-
gnosis of placenta accreta.Obstet Gynecol 2006; 108:573-
Wong HS, Cheung YK, Zuccollo J, Tait J, Pringle JC.
Evaluation of sonographic diagnostic criteria for placenta
accreta. J Clin Ultrasound 2008; 36:551-9
Chou MM, Ho ES, Lee YH. Prenatal diagnosis of plac-
enta previa accreta by transabdominal color Doppler
ultrasound. Ultrasound ObstetGynecol2000; 15:28-35
Lau WC, Fung HY, Rogers MS. Ten year experienceof
caesarean and postpartum hysterectomy in a teaching
hospital in Hong Kong. Eur J Obstet Gynecol Reprod
Biol 1997;74:133-7
Grobman WA, Gersnoviez R, Landon MB.Pregnancy
outcomes for women with placenta previain relation to
the number of prior cesarean deliveries Obstet Gynecol
;110:1249-55
Levine D, Hulka CA, Ludmir J, Li W, Edelman RR.Plac-
enta accreta: evaluation with color Doppler US,power
Doppler US, and MR imaging. Radiology 1997;205:773-6
Japaraj RP, Mimin TS, Mukudan K. Antenatal diagnosis
of placenta previa accreta in patients with previous
cesarean scar. J Obstet Gynaecol Res 2007; 33:431-7
Comstock CH. Antenatal diagnosis of placenta accreta:
a review. Ultrasound Obstet Gynecol 2005;26:89-96
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2015 Rahila Usman, Sumayya Fatima, Sadia Rashid, Sehrish Mehmood, Kashif Shazlee, Kamran Hamid
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Journal of Bahria University Medical & Dental College is an open access journal and is licensed under CC BY-NC 4.0. which permits unrestricted non commercial use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this license, visit https://creativecommons.org/licenses/by-nc/4.0 
