Skip to main content
SpringerLink
Log in

A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging

  • Original Article
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Background

Ultrasound (US) is the first-line imaging modality to assess the morbidly adherent placenta, but sensitivity and specificity are lacking.

Objective

This investigation aims to improve diagnostic accuracy with a comprehensive score using clinical history, US, and magnetic resonance imaging (MRI).

Materials and methods

We conducted a retrospective cohort study of pregnant women who received both transvaginal US and MRI with suspicion for morbidly adherent placenta between 2009 and 2016. US was scored with the following metrics: (i) previa, (ii) hypervascularity, (iii) loss of retroplacental clear space and (iv) lacunae. MRI was evaluated for (i) intraparenchymal vessels, (ii) abnormally dilated vessels, (iii) fibrin deposition, (iv) placental bulge and (v) bladder dome irregularity. Bayesian analysis was used to estimate the probability of morbidly adherent placenta for a given score. Diagnostic testing parameters were calculated.

Results

Among the 41 women with concerning imaging, histologically identified disease was confirmed in 16. The probability of morbidly adherent placenta increased with the score. At the highest US score, the probability of disease was 63.7%. With the highest MRI score, the probability of adherent placentation was 90.5%. Combining the US and MRI findings had a sensitivity of 56% and a specificity of 92%.

Conclusion

A combined scoring system using MRI and US may accurately identify patients at risk for morbidity associated with morbidly adherent placenta.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Gielchinsky Y, Rojansky N, Fasouliotis SJ, Ezra Y (2002) Placenta accreta – summary of 10 years: a survey of 310 cases. Placenta 23:210–214

    Article  CAS  Google Scholar 

  2. Publications Committee, Society for Maternal-Fetal Medicine (2010) Placenta accreta. Am J Obstet Gynecol 203:430–439

    Article  Google Scholar 

  3. Wu S, Kocherginsky M, Hibbard JU (2005) Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 192:1458–1461

    Article  Google Scholar 

  4. Usta IM, Hobeika EM, Musa AA et al (2005) Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 193:1045–1049

    Article  Google Scholar 

  5. Hung TH, Shau WY, Hsieh CC et al (1999) Risk factors for placenta accreta. Obstet Gynecol 93:545–550

    CAS  Google Scholar 

  6. Abuhamad A (2013) Morbidly adherent placenta. Semin Perinatol 37:359–364

    Article  Google Scholar 

  7. Grosvenor A, Silver R, Porter TF, Zempolich K (2006) Optimal management of placenta accreta. Am J Obstet Gynecol 195:S82

    Article  Google Scholar 

  8. Committee on Obstetric Practice (2012) Committee opinion no. 529: placenta accreta. Obstet Gynecol 120:207–211

    Article  Google Scholar 

  9. Royal College of Obstetricians and Gynaecologists (2011) Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Green-top Guideline 27:1–26

    Google Scholar 

  10. Collins SL, Ashcroft A, Braun T et al (2015) Proposal for standardised ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol 47:271–275

    Article  Google Scholar 

  11. Maher MA, Abdelaziz A, Bazeed MF (2013) Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta. Acta Obstet Gynecol Scand 92:1017–1022

    Article  Google Scholar 

  12. Palacios Jaraquemada JM, Bruno CH (2005) Magnetic resonance imaging in 300 cases of placenta accreta: surgical correlation of new findings. Acta Obstet Gynecol Scand 84:716–724

    Article  Google Scholar 

  13. Warshak CR, Eskander R, Hull AD et al (2006) Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 108:573–581

    Article  Google Scholar 

  14. Masselli G, Brunelli R, Casciani E et al (2008) Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol 18:1292–1299

    Article  Google Scholar 

  15. Maldjian C, Adam R, Pelosi M et al (1999) MRI appearance of placenta percreta and placenta accreta. Magn Reson Imaging 17:965–971

    Article  CAS  Google Scholar 

  16. D'Antonio F, Iacovella C, Palacios-Jaraquemada J et al (2014) Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 44:8–16

    Article  CAS  Google Scholar 

  17. Ueno Y, Maeda T, Tanaka U et al (2016) Evaluation of interobserver variability and diagnostic performance of developed MRI-based radiological scoring system for invasive placenta previa. J Magn Reson Imaging 44:573–583

    Article  Google Scholar 

  18. Tovbin J, Melcer Y, Shor S et al (2016) Prediction of morbidly adherent placenta using a scoring system. Ultrasound Obstet Gynecol 48:504–510

    Article  CAS  Google Scholar 

  19. Baughman CW, Corteville JE, Shah RR (2008) Placenta accreta: spectrum of US and MR imaging findings. Radiographics 28:1905–1916

    Article  Google Scholar 

  20. Eller AG, Bennett MA, Sharshiner M et al (2011) Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 117:331–337

    Article  Google Scholar 

  21. Robinson BK, Grobman WA (2010) Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol 116:835–842

    Article  Google Scholar 

  22. Angstmann T, Gard G, Harrington T et al (2010) Surgical management of placenta accreta: a cohort series and suggested approach. Am J Obstet Gynecol 202(38):e1–e38

  23. Rac MW, Dashe JS, Wells CE et al (2015) Ultrasound predictors of placental invasion: the placenta Accreta index. Am J Obstet Gynecol 212(343):e1–e7

    Google Scholar 

  24. Gilboa Y, Spira M, Mazaki-Tovi S et al (2015) A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta. J Ultrasound Med 34:561–567

    Article  Google Scholar 

  25. Derman AY, Nikac V, Haberman S et al (2011) MRI of placenta accreta: a new imaging perspective. AJR Am J Roentgenol 197:1514–1521

    Article  Google Scholar 

Download references

Acknowledgements

This manuscript was a poster presentation at the 2018 American Institute of Ultrasound in Medicine Annual Convention, March 24-28, New York, NY.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Indiana University School of Medicine, 550 N. University Blvd., UH 2440, Indianapolis, IN, 46202, USA

    Jordan C. Knight, Anthony L. Shanks, Lamia Atasi & Sherrine A. Ibrahim

  2. Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA

    Stephen Lehnert, Lisa R. Delaney, Megan B. Marine & Brandon P. Brown

Authors
  1. Jordan C. Knight
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Lehnert
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anthony L. Shanks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lamia Atasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lisa R. Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Megan B. Marine
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sherrine A. Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Brandon P. Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jordan C. Knight.

Ethics declarations

Conflicts of interest

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Knight, J.C., Lehnert, S., Shanks, A.L. et al. A comprehensive severity score for the morbidly adherent placenta: combining ultrasound and magnetic resonance imaging. Pediatr Radiol 48, 1945–1954 (2018). https://doi.org/10.1007/s00247-018-4235-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-018-4235-4

Keywords

Search

Navigation