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Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa

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Abstract

Objective

To evaluate the association of placental thickness with placenta accreta spectrum disorder in placenta previa.

Methods

In this IRB-approved, retrospective study, ultrasound (US) reports were retrospectively queried for keyword previa. US performed closest to mid-gestation were included. Three measurements were performed at the thickest portion of the placenta on longitudinal transabdominal images. Operative reports and surgical pathology were used as the reference standard. Statistical analysis was performed using unpaired T-tests and receiver operating curve (ROC) analysis.

Results

Sixty-five patients with placenta previa were included: 38 with PAS disorder and 27 without PAS disorder, clinically or pathologically. 38/38 (100%) patients of PAS group and 16/27 (59.3%) patients of non-PAS group had history of prior cesarean section. The average placental thickness was 4.3 cm (range 1.8 cm to 7.8 cm) for PAS group and 3.0 cm (range 0.6 cm to 5.3 cm) for non-PAS group (p < 0.001). Placental thickness in patients without PAS disorder and history of prior cesarean section was 3.1 (± 1.1) cm. This was statistically different from patients who had history of prior cesarean section with PAS diagnosis (4.3 cm, P<0.01). Using ROC analysis, a threshold measurement of 4.5 cm leads to sensitivity of 50% and specificity of 96%.

Conclusion

Our results demonstrate that among women with placenta previa, increased placental thickness at lower uterine segment correlates with placenta accreta spectrum disorder. A threshold of 4.5 cm can be useful for screening patients with placenta previa and risks factors for PAS.

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Reference

  1. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol 1993;168: 1424–9.

    Article  CAS  PubMed  Google Scholar 

  2. Cresswell JA, Ronsmans C, Calvert C, Filippi V. Prevalence of placenta previa by world region: a systematic review and metaanalysis. Trop Med Int Health 2013;18:712–24.

    Article  PubMed  Google Scholar 

  3. Getahun D, Oyelese Y, Salihu HM, Ananth CV. Previous cesarean delivery and risks of placenta previa and placental abruption. Obstet Gynecol 2006;107:771–8.

    Article  PubMed  Google Scholar 

  4. Ananth CV, Smulian JC, Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a meta-analysis. Am J Obstet Gynecol 1997;177:1071–8.

    Article  CAS  PubMed  Google Scholar 

  5. Crane JM, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000;17:101–5.

    Article  CAS  PubMed  Google Scholar 

  6. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol 2003;188:1299–304.

    Article  PubMed  Google Scholar 

  7. Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, et al. Transvaginal ultrasonography for all placentas that appear to be low lying or over the internal cervical os. Ultrasound Obstet Gynecol 1997;9:22–4.

    Article  PubMed  Google Scholar 

  8. Lauria MR, Smith RS, Treadwell MC, Comstock CH, Kirk JS, Lee W, et al. The use of second trimester ultrasonography to predict placenta previa. Ultrasound Obstet Gynecol 1996;8: 337–40.

    Article  CAS  PubMed  Google Scholar 

  9. Timor-Tritsch IE, Yunis RA. Confirming the safety of trans- vaginal sonography in patients suspected of having placenta previa. Obstet Gynecol 1993;81:742–4.

    CAS  PubMed  Google Scholar 

  10. Becker RH, Vonk R, Mende BC, Ragosch V, Entezami M. The relevance of placental location at 20–23 gestational weeks for the prediction of placenta previa at delivery: evaluation of 8650 cases. Ultrasound Obstet Gynecol 2001;17: 496–501.

    Article  CAS  PubMed  Google Scholar 

  11. AIUM Practice Parameter for the Performance of Limited Obstetric Ultrasound Examinations by Advanced Clinical Providers, J Ultrasound Med, 2018 Jul; 37(7): 1587-1596

  12. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol 2005;192: 1458–61.

    Article  PubMed  Google Scholar 

  13. Publications Committee, Society for Maternal-Fetal Medicine, Belfort MA. Placenta accreta. Am J Obstet Gynecol 2010;203: 430–9.

    Google Scholar 

  14. Morlando M, Samo L, Napolitano R, Capone A, Tessitore G, Maruotti GM, et al. Placenta accreta: incidence and risk factors in an area with a particularly high rate of cesarean section. Acta Obstet Gynecol Scand 2013;92:457–60.

    Article  PubMed  Google Scholar 

  15. Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY, Thom EA, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006;107:1226–32.

    Article  PubMed  Google Scholar 

  16. Higgins MF, Monteith C, Foley M, O’Herlihy C. Real increasing incidence of hysterectomy for placenta accreta following previous caesarean section. Eur J Obstet Gynecol Reprod Biol 2013;17:54–6.

    Article  Google Scholar 

  17. Clark SL, Koonings PP, Phelan JP. Placenta previa/accreta and prior cesarean section. Obstet Gynecol 1985;66:89–92.

    CAS  PubMed  Google Scholar 

  18. Gyamfi-Bannerman C, Gilbert S, Landon MB, Spong CY, Rouse DJ, Varner MW, et al. Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstet Gynecol 2012;120:1332–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Norwitz ER, Stern HM, Grier H, Lee-Parritz A. Placenta percreta and uterine rupture associated with prior whole body radiation therapy. Obstet Gynecol 2001;98:929–31.

    CAS  PubMed  Google Scholar 

  20. Hare AA, Olah KS. Pregnancy following endometrial ablation: a review article. J Obstet Gynaecol 2005;25:108–14.

    Article  CAS  PubMed  Google Scholar 

  21. Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN, et al. Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gynecol 2011;205:38.e1–6.

    Google Scholar 

  22. Eller AG, Porter TF, Soisson P, Silver RM. Optimal management strategies for placenta accreta. BJOG 2009;116:648–54.

    Article  CAS  PubMed  Google Scholar 

  23. Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 2010;115:65–9.

    Article  PubMed  Google Scholar 

  24. Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta and percreta in the UK: a population-based descriptive study. BJOG 2014;121:62–70.

    Article  CAS  PubMed  Google Scholar 

  25. Shamshiraz AA, Fox KA, Salmanian B, Diaz-Arrastia CR, Lee W, Baker BW, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol2015;212:218.e1–9.

    Google Scholar 

  26. Berkley EM, Abuhamad AZ. Prenatal diagnosis of placenta accreta. Is sonography all we need? J Ultrasound Med 2013; 32:1345–50.

  27. Comstock CH, Bronsteen RA. The antenatal diagnosis of placenta accreta. BJOG 2014;121:171–81.

    Article  CAS  PubMed  Google Scholar 

  28. Bowman ZS, Eller AG, Kennedy AM, Richards DS, Winter TC III, Woodward PJ, et al. Accuracy of ultrasound for the prediction of placenta accreta. Am J Obstet Gynecol 2014;211:210.e1–7.

    Google Scholar 

  29. Bowman ZS, Eller AG, Kennedy AM, Richards DS, Winter TC III, Woodward PJ, et al. Interobserver variability of ultrasound for the prediction of placenta accreta. J Ultrasound Med 2014;33:2153–8.

    Article  PubMed  Google Scholar 

  30. Gielchinsky Y, Mankuta D, Rojansky N, Laufer N, Gielchinsky I, Ezra Y. Perinatal outcome of pregnancies complicated by placenta accreta. Obstet Gynecol 2004;104:527–30.

    Article  PubMed  Google Scholar 

  31. Esakoff TF, Sparks TN, Kaimal AJ, Kim LH, Feldstein VA, Goldstein RB, et al. Diagnosis and morbidity of placenta accreta. Ultrasound Obstet Gynecol 2011;37:324–7.

    Article  CAS  PubMed  Google Scholar 

  32. D’Antonio F, Iacovella C, Palacios-Jarquemada J, Bruno CH, Manzoli L, Bhide A. Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2014;44:8–16.

    Article  PubMed  Google Scholar 

  33. Jauniaux E, Gronbeck L, Collins SL, Epidemiology of placenta previa accreta: a systematic review and meta-analysis. BMJ Open. 2019 Nov 12;9(11):e031193.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Collins SL, Alemdar B, Chantrain F et al; Evidence-based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019 Jun;220(6):511-526.

    Article  PubMed  Google Scholar 

  35. Cahill AG, Beigi R, Wax JR et al; Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018 Dec;219(6):B2-B16.

    Article  PubMed  Google Scholar 

  36. Jauniaux E, Ghide A, Collins S; FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. Int J Gynaecol Obstet. 2018 Mar;140(3):274-280.

  37. Dimitrova I, Jauniaux E, Nicholaides KH; Development of a training program for the ultrasound screening of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019 Oct;147(1):73-77.

    Article  PubMed  Google Scholar 

  38. Zachary S Bowman, Alexandra G Eller, Robert M Silver, Interobserver Variability of Sonography for Prediction of Placenta Accreta J Ultrasound Med. 2014 Dec;33(12):2153-8.

  39. AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations, J Ultrasound Med, 2018 Nov; 37 (11): E13-24

  40. Hecht J, Baergen R, Heller DS et al, Class Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel, Mod Pathol. 2020 Dec; 33 (12) 2382-2396

    Article  PubMed  Google Scholar 

  41. Melcer Y, Jauniaux E, Maymon R et al. Impact of targeted scanning protocols on perinatal outcomes in pregnancies at risk of placenta accreta spectrum or vasa previa. Am J Obstet Gynecol. 2018 Apr; 218(4): 443.e1-443.e8

    Article  Google Scholar 

  42. Amarnath Bhide, Arianna Laoreti, Andrea Kaelin Agten et al, Lower uterine segment placental thickness in women with abnormally invasive placenta, ActaObstet Gynecol Scand. 2019;98:95–100.

  43. Craven CM, Zhao L, Ward K. Lateral placental growth occurs by trophoblast cell invasion of decidual veins. Placenta. 2000;21(2–3):160-169.

    Article  CAS  PubMed  Google Scholar 

  44. Ghourab S (2001) Third-trimester transvaginal ultrasonography in placenta previa: does the shape of the lower placental edge predict clinical outcome? Ultrasound Obstet Gynecol 18:103–108

    Article  CAS  PubMed  Google Scholar 

  45. Zaitoun MM, El Behery MM, Abd El Hameed AA, et al, Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa? Arch Gynecol Obstet (2011) 284:867–873

  46. E Keshavarz, M Motevasselian, M Bakhtiyari et al; Gestational Age-Specific Reference Values of Placental Thickness in Normal Pregnant Women Women Health 2019 Aug;59(7):718-729.

    Article  CAS  PubMed  Google Scholar 

  47. Hironori Takahashi, Shigeki Matubara, Placental Thickness Measurement Is Difficult in Some Cases ta Obstet Gynecol Scand 2019 Feb;98(2):264-265.

    Google Scholar 

  48. Arianna Laoreti, Basky Thilaganathan, Amarnath Bhide et al; Placental Thickness in the Lower Uterine Segment and Invasive Placentation: Will the Promise Live Up? Acta Obstet Gynecol Scand, 2019 Feb;98(2):266.

    Article  PubMed  Google Scholar 

  49. Zhen-Zhen Liu, Yao Wei, Qing Dai et al; Antenatal Sonographic Diagnosis and Clinical Significance of Placenta Previa Accreta After Cesarean Section Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 2017 Oct 30;39(5):693-698

    PubMed  Google Scholar 

  50. Pettit KE, Stephenson ML, Ramos GA et al, Maternal and neonatal outcomes among scheduled versus unscheduled deliveries in women with prenatally diagnosed, pathologically proven placenta accreta. University of California Fetal Consortium. J Matern Fetal Neonatal Med. 2019 Mar;32(6):927-931

  51. Fratto VM, Conturie CL, Ramos GA et al, Assessing the multidisciplinary team approaches to placenta accreta spectrum across five institutions within the University of California fetal Consortium (UCfC). University of California fetal Consortium. J Matern Fetal Neonatal Med. 2019 Oct 24:1-6.

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Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, Box 0628, San Francisco, CA, 94143, USA

    Yan Li, Hailey H. Choi, Ruth Goldstein, Liina Poder & Priyanka Jha

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Li, Y., Choi, H.H., Goldstein, R. et al. Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa. Abdom Radiol 46, 2722–2728 (2021). https://doi.org/10.1007/s00261-020-02894-9

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