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Am J Perinatol 2023; 40(09): 1013-1025
DOI: 10.1055/s-0043-1761914
PAS Series Article
Review Article

Imaging the Uterus in Placenta Accreta Spectrum Disorder

Meena Khandelwal
1   Department of Obstetrics and Gynecology, Cooper Medical School of Rowan University, Camden, New Jersey
,
Thomas D. Shipp
2   Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts
,
Carolyn M. Zelop
3   Department of Obstetrics and Gynecology, Valley Medical Group, Paramus, New Jersey and Clinical Professor of Obstetrics and Gynecology, Ne NYU Grossman School of Medicine, New York
,
Alfred Z. Abuhamad
4   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Yalda Afshar
5   Department of Obstetrics and Gynecology, University of California, Los Angeles, California
,
Brett D. Einerson
6   Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah
,
Karin A. Fox
7   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
,
Thierry A. G. M. Huisman
7   Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas
8   Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houstan, Texas
,
Deirdre J. Lyell
9   Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, California
,
Uma Perni
10   Subspecialty Care for Women's Health, Cleveland Clinic, Beachwood, Ohio
,
Lawrence D. Platt
11   Center for Fetal Medicine & Women's Ultrasound and the David Geffen School of Medicine at UCLA, Los Angeles, California
,
Scott A. Shainker
12   Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
,
for the Pan American Society for Placenta Accreta Spectrum (PAS2)› Author Affiliations
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Abstract

Antenatal diagnosis of placenta accreta spectrum (PAS) improves maternal and neonatal outcomes by allowing for multidisciplinary planning and preparedness. Ultrasound is the primary imaging tool. Simplification and standardization of placental evaluation and reporting terminology allows improved communication and understanding between teams. Prior to 10 weeks of gestation, gestational sac position and least myometrial thickness surrounding the gestational sac help PAS diagnosis very early in pregnancy. Late first-, second-, and third-trimester evaluation includes comprehensive evaluation of the placenta, transabdominal and transvaginal with partially full maternal urinary bladder, and by color Doppler. Subsequently, the sonologist should indicate whether the evaluation was optimal or suboptimal; the level of suspicion as low, moderate, or high; and the extent as focal, global, or extending beyond the uterus. Other complementary imaging modalities such as 3D-power Doppler ultrasound, magnetic resonance imaging (MRI), and vascular topography mapping strive to improve antenatal placental evaluation but remain investigational at present.

Key Points

  • Antenatal imaging, primarily using ultrasound with partially full maternal urinary bladder, is an essential means of evaluation of those at risk for PAS.

  • Simplification and standardization of placental evaluation and reporting will allow improved communication between the multidisciplinary teams.

  • Gestational sac location prior to 10 weeks of gestation and four markers after that (placental lacunae and echostructure, myometrial thinning, hypoechoic zone with or without bulging between placenta and myometrium, and increased flow on color Doppler).

Keywords

placenta accreta - antenatal diagnosis - ultrasound - 3D - Doppler - MRI


Publication History

Article published online:
19 June 2023

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