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Sonographic Findings of Morbidly Adherent Placenta in the First Trimester
Author(s) -
Rac Martha W. F.,
Moschos Elysia,
Wells C. Edward,
McIntire Donald D.,
Dashe Jodi S.,
Twickler Diane M.
Publication year - 2016
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.15.03020
Subject(s) - medicine , placenta previa , obstetrics , placenta , placenta accreta , hysterectomy , confidence interval , gynecology , pregnancy , placentation , radiology , fetus , genetics , biology
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.