DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174408

Efficacy of colour doppler imaging in prediction of placenta accrete

Rachna Agarwal, Sruthi Bhaskaran, Esha Gupta, Dipanvita Dutta, Anupama Tandon

Abstract


Background: In present scenario of increasing cases of previous caesarean section the diagnosis of Placenta accreta preoperatively is of great value to the attending obstetrician. This helps in preparing, counselling the patient and also in assembling a multidisciplinary team for effective peripartum clinical management of these patients to prevent maternal morbidity and mortality.

Methods: One hundred patient with persistent placenta previa after 28 weeks gestation were screened by grey scale B mode sonography. In suspicious cases of placenta accreta, further assessment by colour Doppler ultrasound was done. The color doppler imaging (CDI) criteria used were - diffuse intra parenchymal placental lacunar flow, focal intra parenchymal placental lacunar flow, bladder-uterine serosa interphase hypervascularity, prominent sub-placental venous complex and loss of sub-placental vascular signal in areas lacking peripheral sub-placental hypoechoic zone. Patients were prospectively followed up till delivery and the CDI findings were analysed with reference to final diagnosis made during caesarean section.

Results: Six of hundred patients exhibited characteristic CDI patterns highly specific for placenta accreta according to the criteria used. In all 6 patients, morbidly adherent placenta was present intraoperatively. The sensitivity and specificity of CDI in the diagnosis of placenta accreta in presentstudy was 100%. Caesarean hysterectomy was required in five patients. Patients with CDI features of lacunar flow had higher incidence of blood loss, transfusion requirements and need for caesarean hysterectomy compared to patients with nonlacunar flow. The remaining 94 patients with placenta previa, not suspicious for placenta accreta on sonography underwent uncomplicated caesarean section.

Conclusions: The use of CDI along with conventional grey-scale sonography improves the diagnostic accuracy for prediction of placenta accreta in patients with persistent placenta previa.


Keywords


Colour Doppler, Placenta previa, Placenta accrete, Ultrasound

Full Text:

PDF

References


Zorlu CG, Turan C, Islik AZ, Danisman N, Mungan T, Gokmen O. Emergency hysterectomy in modern obstetric practice. Acta Obset Gynecol Scand. 1998;77:186-90.

Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226-32.

Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. 2005;193:1045-9.

Lam G, Kuller J, McMahon M. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. J Soc Gynecol Invest. 2002;9:37-40.

Lerner JP, Deane S, Timor-Tritsch IE. Characterization of placenta accreta using transvaginal sonography and colour Doppler imaging. Ultrasound Obstet Gynecol. 1995;5:198-201.

American College of Obstetricians and Gynecologists. Placenta accreta: committee opinion no. 529. Obstet Gynecol. 2012;120:207-211.

Levine D, Hulka CA, Ludmir J, Li W, Edelman RR. Placenta accreta: evaluation with colour Doppler US, power Doppler US, and MR imaging. Radiology 1997;205(3):773-6.

Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal colour Doppler ultrasound. Ultrasound Obstet Gynecol. 2000;15:28-35.

Finberg HJ, Williams JW. Placenta accreta; prospective sonographic diagnosis in patients with placenta previa and prior caesarean section. J Ultrasound Med. 1992;11:333-43.

Guy G, Peisner DB, Timor­Tritsch IE. Ultrasonographic evaluation of uteroplacental blood flowpatterns of abnormally located and adherent placentas. Am J Obstet Gynecol. 1990;163:723-7.

Twickler DM, Lucas MJ, Balis AB, Santos-Ramos R, Martin L, Malone S et al. Colour flow mapping for myometrial invasion in women with a prior cesarean delivery. J Matern Fetal Med. 2000;9:330-5.

Silver LE, Hobel CJ, Lagasse L, Luttrull JW, Platt LD. Placenta previa percreta with bladder involvement; new considerations and review of the literature. Ultrasound Obstet Gynecol. 1997;9:131-8.