Does Ultrasound Feature of Morbidity Adherent Placenta Give Us a Lead to Decide a  Uterine Salvage Surgery

Authors

  • Uzma Urooj Department of Obstetrics & Gynecology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Asifa Siraj Department of Obstetrics & Gynecology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Mahpara Tariq Department of Obstetrics & Gynecology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Sumaira Khan Department of Obstetrics & Gynecology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Shaheera Akram Department of Obstetrics & Gynecology, Pak Emirates Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
  • Shazia Afzal Department of Obstetrics & Gynecology, Combined Military Hospital, Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75iSUPPL-6.12159

Keywords:

Accreta, Increta, Placenta Prveia, Placenta accreta syndrome, Ultrasound features

Abstract

Objective: To correlate and confirm the ultrasonography diagnosis of placenta accreta spectrum with surgical findings.

Study Design: Cross-sectional study.

Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2023 to Apr 2024.

Methodology:  During pregnancy, ultrasound is a frequently utilised imaging modality that provides a non-invasive way to evaluate the placenta's features as well as its characteristics. The cohort comprised women with placenta previa and a history of at least one prior cesarean section or any other uterine surgery.

Results: The mean maternal age was 23.6±5.1years and mean gestational age at birth was reported as 34.3±2.5 weeks. In comparing each sonography index, the presence of bladder interruption (kappa: 0.838, sensitivity: 86%, specificity: 100%) and subplacental hypervascularity (kappa: 0.808, sensitivity: 85.3%, specificity: 95%) demonstrated the highest concordance for diagnosing PAS when evaluated against the gold standard diagnosis. Pateints diagnosed with PAS 1,2,3, on ultrasound were 59(71.9%). PAS 1 were 19(23.1%), PAS 2 were 26(31.7%) and PAS 3 were 14(17.07%).  Upon surgical correlation, out of these 59 patients 48(81.3%) were surgically confirmed to have PAS. Out of these sugically confirmed patients, PAS 1 was in 14(73.6%), PAS 2 in 23(88.4%) and PAS 3 was in 13(92.8%) of patinets. Adverse surgical outcomes occurred in 11.8% of pregnancies, with a 95% confidence interval ranging from 7.9% to 17.2%.

Conclusion:  Ultrasound diagnosis plays a crucial role not only in detecting placental invasion but also in facilitating its preliminary classification as it was confirmed during surgery.

Downloads

Download data is not yet available.

References

1. Eller AG, Bennett MA, Sharshiner M, Masheter C, Soisson AP, Dodson M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011; 11(7): 331–337

https://doi.org/10.1097/AOG.0b013e3182051db2

2. Jauniaux E, Collins SL, Burton GJ. Placenta accreta spectrum: Pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2019; 2(18): 75-87.

https://doi.org/10.1016/j.ajog.2017.05.067

3. Hecht JL, Baergen R, Ernst LM, Katzman PJ, Jacques SM, Jauniaux E et al. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Mod Pathol 2020; 33: 2382-2396.

https://doi.org/10.1038/s41379-020-0569-1

4. Palacios-Jaraquemada JM, Fiorillo A, Hamer J, Martínez M, Bruno C. Placenta accreta spectrum: a hysterectomy can be prevented in almost 80% of cases using a resective-reconstructive technique. J Matern Fetal Neonatal Med 2020; 26: 1-8. https://doi.org/10.1080/14767058.2020.1716715

5. Hussein AM, Ramzy A, Jauniaux E. Increasing caesarean delivery rates in Egypt: the impact of maternal request. BJOG 2020; 13: 11-14.

https://doi.org/10.1111/1471-0528.16494

6. Jauniaux E, D'Antonio F, Bhide A, Prefumo F, Silver RM, Hussein AM, Shainker SA, Chantraine F, Alfirevic Z; Delphi consensus expert panel. Modified Delphi study of ultrasound signs associated with placenta accreta spectrum. Ultrasound Obstet Gynecol 2023; 61(4): 518-525.

https://doi.org/10.1002/uog.26155

7. Hussein AM, Elbarmelgy RA, Elbarmelgy RM, Thabet MM, Jauniaux E. Prospective evaluation of impact of post-Cesarean section uterine scarring in perinatal diagnosis of placenta accreta spectrum disorder. Ultrasound Obstet Gynecol 2022; 59(4): 474-482. https://doi.org/10.1002/uog.23732

8. Fratelli N, Prefumo F, Maggi C, Cavalli C, Sciarrone A, Garofalo A et al. ADoPAD (Antenatal Diagnosis of Placental Adhesion Disorders) Working Group. Third-trimester ultrasound for antenatal diagnosis of placenta accreta spectrum in women with placenta previa: results from the ADoPAD study. Ultrasound Obstet Gynecol 2022; 60(3): 381-389.

https://doi.org/10.1002/uog.24889

9. Coutinho CM, Giorgione V, Noel L, Liu B, Chandraharan E, Pryce J et al. Effectiveness of contingent screening for placenta accreta spectrum disorders based on persistent low-lying placenta and previous uterine surgery. Ultrasound Obstet Gynecol 2021; 57(1): 91-96.

https://doi.org/10.1002/uog.23100

10. Shainker SA, Coleman B, Timor-Tritsch IE, Bhide A, Bromley B, Cahill AG et al. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. American Journal of Obstetrics and Gynecology 2021; 224(1): 2-14.

11. Maged AM, El-Mazny A, Kamal N, Mahmoud SI, Fouad M, El-Nassery N, Kotb A, Ragab WS, Ogila AI, Metwally AA, Lasheen Y. Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis. BMC Pregnancy and Childbirth 2023; 5; 23(1): 354.

https://doi.org/10.1186/s12884-023-05675-6

12. Skupski DW, Duzyj CM, Scholl J, Perez‐Delboy A, Ruhstaller K, Plante LA et al. Evaluation of classic and novel ultrasound signs of placenta accreta spectrum. Ultrasound in Obstetrics & Gynecology 2022; 59(4): 465-73.

https://doi.org/10.1002/uog.24804

13. Alalfy M, Hamed ST, El GASA. The accuracy of 3D-TUI and 3D power Doppler using Alalfy simple criteria in the diagnosis of placenta accreta spectrum. Clin Exp Obstet Gynecol 2021; 48(5): 1132–40. https://doi.org/10.31083/j.ceog4805182

14. Morel O, van Beekhuizen HJ, Braun T. Performance of antenatal imaging to predict placenta accreta spectrum degree of severity. Acta Obstet Gynecol Scand. 2021; 100(S1): 21–8.

https://doi.org/10.1111/aogs.14112

15. Marsoosi V, Ghotbizadeh F, Hashemi N, Molaei B. Development of a scoring system for prediction of placenta accreta and determine the accuracy of its results. J Matern Neonatal Med 2020; 33(11): 1824–1830.

https://doi.org/10.1080/14767058.2018.1531119

16. Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2021; 72: 13–24.

https://doi.org/10.1016/j.bpobgyn.2020.06.010

17. Asghar S, Naz N. Diagnostic Accuracy of Doppler Ultrasound for Antenatal Detection of Placenta Accreta Spectrum (PAS) Disorders. J Gynecol Obstet 2020; 8: 12–15

18. Xia H, Ke S-C, Qian R-R, Lin J-G, Li Y, Zhang X et al. Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy. Medicine (Baltimore) 2020; 99: e17908.

https://doi.org/10.1097/MD.0000000000017908

19. Happe SK, Yule CS, Spong CY, Wells CE, Dashe JS, Moschos E et al. Predicting Placenta Accreta Spectrum: Validation of the Placenta Accreta Index. J Ultrasound Med 2021; 40: 1523–1532.

https://doi.org/10.1002/jum.15530

20. Hashim HA, Shalaby EM, Hussien MH, Rakhawy ME. Diagnostic accuracy of the placenta accreta index for placenta accreta spectrum: A prospective study. Int J Gynaecol Obstet 2022; 156: 71–76.

https://doi.org/10.1002/ijgo.13610

21. Perotto L, Zimmermann R, Quack Loetscher KC. Maternal mortality in Switzerland 2005–2014. Swiss Med Wkly 2020; 150: w20345.

https://doi.org/10.4414/smw.2020.20345

22. Hobson SR, Kingdom JC, Murji A, et al. No. 383-screening, diagnosis, and management of placenta accreta spectrum disorders. J Obstet Gynaecol Can 2019; 41(7): 1035-1049.

https://doi.org/10.1016/j.jogc.2018.12.004

23. Lee W, Fox KA, Cassady CI, et al. Placenta accreta spectrum 2021: roundtable discussion. J Ultrasound Med 2022; 41: 7-15.

https://doi.org/10.1002/jum.15685

Downloads

Published

30-09-2025

Issue

Section

Original Articles

How to Cite

1.
Urooj U, Siraj A, Tariq M, Khan S, Akram S, Afzal S. Does Ultrasound Feature of Morbidity Adherent Placenta Give Us a Lead to Decide a  Uterine Salvage Surgery. Pak Armed Forces Med J [Internet]. 2025 Sep. 30 [cited 2025 Oct. 6];75(SUPPL-6):S945-S950. Available from: https://pafmj.org/PAFMJ/article/view/12159