Role of Color Doppler Ultrasound in Prediction of Adherent Placenta Previa

Zahia Elghazal, Ream Langhe, Nagat Bettamer, Asma Elmahgoub

Abstract


Introduction

Adherent placenta is a decidualisation disorder that includes placenta accreta, increta, and percreta. They are uncommon but potentially life-threatening conditions due to the risk of massive hemorrhage that may warrant hysterectomy. Risk factors include age, multiparity, previous uterine scar and placenta previa. Prediction of adherent placenta is possible using color Doppler ultrasonography.

The aims of this study are to describe the pattern of adherent placenta among cases of placenta previa and to investigate diagnostic performance of abdominal ultrasound scanning and Doppler ultrasound in diagnosis of adherent placenta among placenta previa.

 

Materials and methods

A prospective study over a 4-month period from August 2016 – November 2016 with institutional ethical approval was conducted in Benghazi Medical Centre, Libya. Ninety-one women with placenta previa complicated pregnancies, who had Doppler ultrasound at 36 weeks gestation, were included in the study.

Results

Of 91 cases of placenta previa, 16.5% among them were adherent. Risk factors for adherent placenta in placenta previa only included the history of previous scars as more cesarean sections was significantly related to the occurrence of adherent placenta (P = 0.029). Presence of previous scar confers a high sensitivity (86.7%) and a high negative predictive value (94.3%). Doppler ultrasound predicted adherent placenta with different signs, the most sensitive being retroplacental hypervascularity and placenta covering the os (86.7%) while serosal disruption was the most specific sign (100.0%). The highest overall test performance signs were serosal disruption (89.0%), followed by presence of lacunae and absence of retroplacental clear zone (both 85.7%).

Conclusion

Placenta previa confers high risk for adherent placenta, with 16.5% of cases of placenta previa having adherent placenta. Doppler ultrasound predicted adherent placenta with different signs, the most sensitive being retroplacental hypervascularity and placenta covering the os while serosal disruption was the most specific sign. Further well-designed research investigating abnormal decidualisation disorders and factors related to adherent placenta is required.


Keywords


Placenta praevia, color doppler, placenta accreta

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References


Ebrahim A, Zaiton F, Elkamash T. Clinical and ultrasound assessment in patients with placenta previa to predict the severity of intrapartum hemorrhage. The Egyptian Journal of Radiology and Nuclear Medicine. 2013; 44: 657-663.

WHO, UNICEF, UNFPA and the World Bank. Trends In Maternal Mortality: 1990-2010, WHO, Geneva, 2012.

Chou MM. Prenatal diagnosis and perinatal management of placenta previa accreta: past, present, and future. Taiwanese J Obstet. Gynecol. 2004; 43(2): 64-71.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty- year analysis. AJOG. 2004; 12: 07.

Palova E, Redecha M, Malova A, Hammerova L, Kosibova Z. Placenta accreta as a cause of peripartum hysterectomy. Bratisl Lek Listy. 2016; 117(4): 212-6 (ISSN: 0006-9248).

Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta, American Institute Of Ultrasound In Medicine, J Ultrasound Med. 2013; 32:1345-1350.

Hudon L, Belfort MA, Broome DR. Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surv. 1998; 53: 509–17.

Yap YY, Perrin LC, Pain SR, Wong SF, Chan FY. Manual removal of suspected placenta accreta at cesarean hysterectomy. Int J Gynaecol Obstet 2008; 100: 186–7.

Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG. 2009; 116(5): 648–54.

Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. American Journal of Obstetrics and Gynecology. 1997; 177(1): 210-4.

Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat Cesarean deliveries. Obstet Gynecol. 2006; 107 (6): 1226-1232.

Laban M, Ibrahim E, Elsafty M, Hassanin A. Placenta accreta is associated with decreased natural killer (dNK) cells population: a comparative pilot study. Eur J Obstet Gynecol Reprod Bio. 2014; 181: 284–8. [PubMed: 25195203].

Bryant-Greenwood G, Yamamoto S, Lowndes K, et al. Human decidual relaxin and preterm birth. Ann N Y Acad Sci. 2005; 1041:338–44. [PubMed: 15956731].

Millar L, Streiner N, Webster L, et al. Early placental insulin-like protein (INSL4 or EPIL) in placental and fetal membrane growth. Biol Reprod. 2005; 73:695–702. [PubMed: 15958731].

Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Green-top Guideline No. 27. January 2011.

Baughman WC, Carterville JE, Shah RR. Placenta accreta: Spectrum of US and MR imaging findings. Radiographics. 2008; 28:1905-17.

Yang JI, Lim YK, Kim HS, Chang KH, Lee JP, Ryu HS. Sonographic findings of placental lacunae and the prediction of adherent placenta in women with placenta previa totalis and prior Cesarean section. Ultrasound in Obstetrics & Gynecology. 2006; 28(2):178-82.

de Mendonca LK. Sonographic diagnosis of placenta accreta. Presentation of six cases. Journal of Ultrasound in Medicine. 1988; 7(4): 211-5.

Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound in Obstetrics & Gynecology. 2005; 26(1): 89-96.

Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K, Resnik R. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006; 108: 573–581.

Chattopadhyay SK, Kharif H, Sherbeeni MM. Placenta praevia and accreta after previous caesarean section. European Journal of Obstetrics & Gynaecology and Reproductive Biology. 1993; 52(3): 151-6.


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