Gynecology & Obstetrics
Open Access
ISSN: 2161-0932
ISSN: 2161-0932
Astrit Bimbashi
Koco Gliozheni, Albania
Posters & Accepted Abstracts: Gynecol Obstet
Discussion: Placenta accreta is a potentially life-threatening obstetric condition. The incidence of placenta accreta has increased
and seems to parallel the increasing cesarean delivery rate. Diagnosis of placenta accreta before delivery allows multidisciplinary
planning in an attempt to minimize potential maternal or neonatal morbidity and mortality. Antenatal sonographic imaging can
be complemented by magnetic resonance imaging in equivocal cases to distinguish those women at special risk of placenta accreta.
Aim: The purpose of this study is to summarize our experience and to describe the diagnostic modalities used for placenta previa,
a morbidly adherent placenta and how they are applied during the antenatal period, with the particular interest in determining the
accuracy of transabdominal and transvaginal gray-scale and color Doppler compared to the findings from MRI.
Methods: A retrospective study of all the cases of placenta previa during the last 12 years in our hospital, analyzing the rate of suspicion
for accreta, comparing the results from sonography and MRI. Both the imaging findings were compared with final diagnosis at the
time of delivery and/or pathologic examination of the specimen after hysterectomy.
Results: We had 234 cases of placenta previa, of these 36 morbidly adherent: 18 percreta, 12 accreta vera, and 6 increta. All patients
in the accreta spectrum group had the history of the previous cesarean section. All the cases were managed by respective surgery
(i.e total or subtotal cesarean hysterectomy). The sonographic characteristics of a placenta accreta taken into consideration during
the US examinations were the absence of the normal retroplacental clear space, placental tissue contiguous with myometrium, and
prominent placental venous lakes and hypervascularity of serosaâ??bladder interface. In each case at least one diagnostic criterion
was present. 30 cases were suspected by ultrasound, all complemented by MRI, with the same results: correct identification of the
presence of placenta accrete. 6 of the cases were un-followed pregnant women, that presented as acute bleeding in the third trimester
and was performed emergency CS with an intraoperative diagnosis of accreta. It took at least 3 days after the examination to get the
results of all the MRI. Only in one case, there was no correlation between the degree of penetration suspected by US and MRI: a case
of suspected increta that resulted in accreta vera. 74% of peripartum hysterectomies were done for placenta accreta. None of the MRI
or sonography was done in an emergency setting. Incidence for the last two years was 1:5000 births for 2016 and 1:1000 for 2017.
Conclusions: Both Grayscale and Doppler ultrasonography and MRI are sensitive enough and specific enough for the diagnosis
of placenta accreta. MRI is more costly than ultrasonography, the relatively lengthy examination, and requires experience in the
evaluation of abnormal placental invasion, it may be useful for clarifying the diagnosis in the case of ambiguous findings with
ultrasound.
E-mail: astritbimbashi@yahoo.com