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Ultrasound Diagnosis of the Morbidly Adherent Placenta
Published in Robert M. Silver, Placenta Accreta Syndrome, 2017
Eliza M. Berkley, Alfred Abuhamad
Placenta accreta is a major complication of pregnancy with substantial maternal morbidity and mortality. Prenatal diagnosis of placenta accreta minimizes pregnancy complications as it allows for a multidisciplinary approach to care and planning for delivery. Undoubtedly, ultrasound markers of placenta accreta play a significant role in prenatal diagnosis. The presence of multiple vascular placental lacunae, increased placental vascularity, and/or posterior bladder wall abnormalities appear to play a critical role in ultrasound diagnosis. It is important to note, however, that the presence of prior cesarean deliveries in association with a placenta previa substantially increases the risk for an accreta.
Placenta previa and placental abruption
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
A significant risk associated with placenta previa is placenta accreta. Placenta accreta is abnormal attachment of the placenta, with an absence of deciduas basilas and an incomplete development of the fibrinoid layer. More severe variants are placenta increta and percreta, with placental extension into the myometrium and through the myometrium, respectively. Two significant risk factors for placenta accreta formation are history of a prior cesarean section and a diagnosis of placenta previa. In a patient with a placenta previa and no prior uterine scar, the risk of an accreta is 3%. However, in patients with one cesarean section and a previa, the accreta risk is 11% and increases to 67% in those with four prior cesareans (33). In the absence of a placenta previa, placenta accreta is rare (34). Because of the significant risk associated with placenta accreta, investigators have attempted to elucidate ultrasonographic signs to accurately diagnose this condition. Multiple irregular vascular spaces in the placenta have been associated with accrete (Figure 3) (15). Other ultrasonographic signs include loss of the normal hypoechoic zone behind the placenta, focal exophytic masses in the placental bed, and a disturbed bladder–uterine connection (33,35). Doppler may also be helpful in making this diagnosis (33,35). MRI can also be used as an adjuvant tool to assess placental invasion. In one study when the placenta was implanted anteriorly overlying a previous cesarean section scar, 29% of cases were accreta (34). The major morbidity associated with accreta is postpartum hemorrhage and maternal blood loss; 55% of cases require blood transfusion, and in 15% of cases, there can be more than 5 liters of blood loss (34). Other surgical complications include ureteral transection, cystotomy, disseminated intravascular coagulation, hypotensive shock, and enterotomy.
A 29-year-old woman presenting for urgent cesarean hysterectomy: a multidisciplinary care challenge
Published in Baylor University Medical Center Proceedings, 2023
Claudia Serrano, Jessica C. Ehrig, Michael P. Hofkamp
Cesarean hysterectomy is a technically challenging procedure in part due to the significant increase in blood flow to the uterus at term. Often, this procedure is performed when the life of the mother or fetus is found to be at risk. The major risk factors for developing placenta accreta syndrome include myometrial trauma and scarring from previous repeated dilation and curettage, smoking, grand multiparity, and recurrent miscarriages.1 This patient’s history of eight prior spontaneous abortions may have contributed to her development of placental abnormality. These defects in endometrial-myometrial interfacing can lead to a failure of normal decidualization in the area of a uterine scar and allow abnormal deep placental anchoring of the villi and infiltration of trophoblast formation.
Recurrence of Basal Plate Myofibers, with Further Consideration of Pathogenesis
Published in Fetal and Pediatric Pathology, 2019
Debra S. Heller, Rachel Wyand, Stewart Cramer
A limitation of this study is the lack of systematic chart reviews, although this may not have been fruitful. This limits clinicopathologic correlation, particularly in regard to which of these cases might qualify for a clinical diagnosis of placenta accreta (morbidly adherent placenta). However, in routine practice at this community hospital, clinicians generally do not diagnose placenta accreta unless there is a hysterectomy. This conforms with the CAP analysis in 1997, which noted that accreta is usually diagnosed accurately only when there is a hysterectomy (1). Stanek and Drummond gave criteria for diagnosing clinically occult placenta accreta in a delivered placenta in 2007 (14), and this practice appears to have been adopted by some experts in placental pathology (9,11–13); but at this community hospital, we have taken the position that such cases should be sent out for expert consultation, whenever this may be requested by our clinicians. Such requests occur roughly once a year or less.
High-intensity focused ultrasound combined procedures treatment of retained placenta accreta with marked vascularity after abortion or delivery
Published in International Journal of Hyperthermia, 2019
Xuefeng Jiang, QiongLan Tang, Binjiang Yang, Fei Ye, Lei Cai, Xiaoyu Wang, Xin Luo, Hong Bu
Placenta accreta (PA) is a general term used to describe the clinical condition when part or all placenta invades and becomes inseparable from the uterine wall after abortion or delivery [1]. As a result, a part of the placenta cannot separate after delivery, which may trigger life-threatening complications such as a catastrophic hemorrhage, hemorrhagic shock, uterine rupture, infection and coagulation disorders when the implanted tissue is massive and deep, with a rich blood supply. The increasing number of cesarean sections has increased the incidence of PA [2]. The incidence of PA has increased ten-fold over the past 30 years in China [3]. The incidence of conservative treatments such as uterine artery embolization (UAE) or methotrexate has increased gradually, replacing hysterectomy. However, the disadvantage of conservative treatment still exist, including the risk of bleeding or infection and the risk of requiring a secondary hysterectomy [3,4]. PA is an important obstetric problem in medical practice and the preservation of the uterus remains a clinical challenge in the management of retained PA with marked vascularity. Over the past decade, ultrasound-guided high-intensity focused ultrasound (USgHIFU) has been used to treat PA [5–8], however, such combined procedures: HIFU combined with systemic MTX followed by ultrasound-guided curettage or hysteroscopic resection, have never been systemically studied.