Imaging the Uterus in Placenta Accreta Spectrum Disorder

Meena Khandelwal; Thomas D. Shipp; Carolyn M. Zelop; Alfred Z. Abuhamad; Yalda Afshar; Brett D. Einerson; Karin A. Fox; Thierry A. G. M. Huisman; Deirdre J. Lyell; Uma Perni; Lawrence D. Platt; Scott A. Shainker; for the Pan American Society for Placenta Accreta Spectrum (PAS2)

doi:10.1055/s-0043-1761914

American Journal of Perinatology, Table of Contents

Am J Perinatol 2023; 40(09): 1013-1025
DOI: 10.1055/s-0043-1761914

PAS Series Article

Review Article

Imaging the Uterus in Placenta Accreta Spectrum Disorder

Meena Khandelwal

¹Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey

,

Thomas D. Shipp

²Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts

,

Carolyn M. Zelop

³Department of Obstetrics and Gynecology, Valley Medical Group, Paramus, New Jersey and Clinical Professor of Obstetrics and Gynecology, Ne NYU Grossman School of Medicine, New York

,

Alfred Z. Abuhamad

⁴Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

,

Yalda Afshar

⁵Department of Obstetrics and Gynecology, University of California, Los Angeles, California

,

Brett D. Einerson

⁶Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah

,

Karin A. Fox

⁷Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

,

Thierry A. G. M. Huisman

⁷Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas

⁸Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houstan, Texas

,

Deirdre J. Lyell

⁹Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California

,

Uma Perni

¹⁰Subspecialty Care for Women's Health, Cleveland Clinic, Beachwood, Ohio

,

Lawrence D. Platt

¹¹Center for Fetal Medicine & Women's Ultrasound and the David Geffen School of Medicine at UCLA, Los Angeles, California

,

Scott A. Shainker

¹²Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

,

for the Pan American Society for Placenta Accreta Spectrum (PAS2)

› Author Affiliations

Abstract

Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present.

Key Points

Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.
Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.
Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler).

Keywords

placenta accreta - antenatal diagnosis - ultrasound - 3D - Doppler - MRI

Full Text

References

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