Sensitivity of antenatal ultrasound in diagnosing posterior placenta accreta spectrum disorders

Gabriela Dellapiana; Thalia Mok; Lawrence D. Platt; Neil S. Silverman; Christina S. Han; Tania F. Esakoff

doi:10.1515/jpm-2023-0491

Article

Sensitivity of antenatal ultrasound in diagnosing posterior placenta accreta spectrum disorders

Gabriela Dellapiana , Thalia Mok , Lawrence D. Platt , Neil S. Silverman , Christina S. Han and Tania F. Esakoff

Published/Copyright: January 22, 2024

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From the journal Journal of Perinatal Medicine Volume 52 Issue 3

Abstract

Objectives

Optimal management of placenta accreta spectrum (PAS) requires antenatal diagnosis. We sought to evaluate the sensitivity of ultrasound findings suggestive of PAS in detecting posterior PAS.

Methods

Cohort study of patients with posterior placentation and pathology-confirmed PAS from 2011 to 2020 at a tertiary center. Patients were excluded if ultrasound images were unavailable. Ultrasounds were reviewed for presence of lacunae, hypervascularity, myometrial thinning, loss of the hypoechoic zone, bridging vessels, abnormal uterine serosa–bladder interface, placental bulge, placental extension into/beyond the myometrium, and an exophytic mass. Risk factors, postpartum outcomes, and ultrasound findings were compared by antepartum suspicion for PAS. Sensitivity was calculated for each ultrasound finding.

Results

Thirty-three patients were included. PAS was not suspected antenatally in 70 % (23/33). Patients with unsuspected PAS were more likely to be non-Hispanic, have in vitro fertilization, no prior Cesarean deliveries, no placenta previa, and delivered later in gestation. Depth of invasion and estimated blood loss were less for unsuspected PAS, but there was no difference in hysterectomy between groups. Ultrasound findings were less frequently seen in those who were not suspected antenatally: lacunae 17.4 vs. 100 % (p<0.001), hypervascularity 8.7 vs. 80 % (p<0.001), myometrial thinning 4.4 vs. 70 % (p<0.001), and placental bridging vessels 0 vs. 60 % (p<0.001). There was poor sensitivity (0–42.4 %) for all findings.

Conclusions

Posterior PAS is less likely to be detected antenatally due to a lower sensitivity of typical ultrasound findings in the setting of a posterior placenta. Further studies are needed to better identify reliable markers of posterior PAS.

Keywords: accuracy; detection; increta; morbidly adherent placenta; percreta

Corresponding author: Gabriela Dellapiana, MD, Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, Cedars-Sinai Medical Center, 8635 W. 3rd Street, Suite 160-W, Los Angeles, CA 90048, USA, Phone: (310) 423 7417, Fax: (310) 432 0313, Mobile: (801) 910 8654, E-mail: gabriela.dellapiana@cshs.org

Research ethics: Institutional Review Board approval and a waiver of informed consent were obtained.
Informed consent: Not applicable.
Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The raw data can be obtained on request from the corresponding author.

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Received: 2023-11-20

Accepted: 2024-01-01

Published Online: 2024-01-22

Published in Print: 2024-03-25

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Articles in the same Issue

https://doi.org/10.1515/jpm-2023-0491

Keywords for this article

accuracy; detection; increta; morbidly adherent placenta; percreta