Placenta ACCRETA: can prenatal diagnosis be performed?

Introduction:

Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate.

Objective:

To list factor risks of placenta accreta.

To list ultrasonography signs identified when a placenta accreta is suspected

To analyze the relevance of diagnosis with ultrasonography and magnetic resonance imaging

Patients and methods:

We conducted a retrospective study covering three years period from 2009 to 2012 in the maternity center Rabta Tunis A

Results:

The prevalence of placenta accrete was 1/1694 in our serie

The mean age was 36 years old

Diagnosis was suspected after metrorrhagia for 41%

The term diagnosis was 32weeks (22 – 40 weeks), the cesarean was at 36weeks (31 – 40,5)

12 women with antenatal suspicion for placenta accreta were identified by ultrasound examination for 9 and 3 by ultrasonography and magnetic resonance imaging.

The most frequently ultrasonography signs are: intra-placental lacuna (58,33%), abnormal vascularization (55%), loss of normal hypoechoic retroplacental myometrial zone (25%), irregularity of the vesical wall (8,33%).

Sensibility of ultrasonography screening is 78%, specificity 96%

Three magnetic resonance imaging examinations executed secondarily confirmed the diagnosis in 66.7% of the cases.

Conclusion:

Women at greatest risk of placenta accreta are those who have myometrial damage caused by an earlier cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar.

Although a planned delivery is the goal, a contingency plan for emergency delivery should be developed for each patient.