Sonographic Findings of Morbidly Adherent Placenta in the First Trimester. (11th December 2015)

• Record Type: Journal Article
• Authors: Rac, Martha W. F.; Moschos, Elysia; Wells, C. Edward; McIntire, Donald D.; Dashe, Jodi S.; Twickler, Diane M.
• Is Part Of: Journal of ultrasound in medicine. Volume 35:Number 2(2016)
• Page Start: 263
• Page End: 269
• Publication Date: 2015-12-11
• Subjects: first trimester -- morbidly adherent placenta -- obstetric ultrasound -- sonography; Ultrasonics in medicine -- Periodicals; Ultrasonics; Ultrasonography; Ultrasonics in medicine; Electronic journals; Periodicals; Periodicals; 616.07543
• DOI: 10.7863/ultra.15.03020
• Languages: English
• ISSNs: 0278-4297

Abstract

Abstract : Objectives: The purpose of this study was to evaluate the association between first‐trimester sonographic findings and morbidly adherent placenta at delivery. Methods: We conducted a retrospective review of all first‐trimester sonographic examinations from pregnancies that underwent third‐trimester sonography for placenta previa or low‐lying placenta between September 1997 and October 2011. Only women with a prior cesarean delivery were included. Transabdominal and transvaginal images from these first‐trimester studies were reviewed for the following sonographic parameters: distance from the inferior border of the gestational sac to the external cervical os, location of the decidua basalis, presence of anechoic areas, uterine‐bladder interface irregularity, and smallest anterior myometrial thickness. Morbidly adherent placentation was confirmed on histologic examination of hysterectomy specimens. Statistical methods included univariate and multivariate analyses. Results: Thirty‐nine patients met inclusion criteria, of whom 14 (36%) had confirmed placental invasion. The number of prior cesarean deliveries was significantly associated with placental invasion ( P < .0001). The only first‐trimester sonographic finding associated with invasion was the smallest anterior myometrial thickness measured in the sagittal plane ( P < .02). Multivariate analysis based on these two variables yielded an area under the receiver operating characteristic curve of 0.94 (95% confidence interval, 0.87–1.00) and significantly improved the prediction of placental invasion compared to using the number of prior cesarean deliveries alone. Conclusions: In women with persistent placenta previa or low‐lying placenta and prior cesarean delivery, the smallest anterior myometrial thickness on first‐trimester sonography significantly improved detection of morbidly adherent placenta.