Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

OBSTETRIC IMAGING
Year
: 2004  |  Volume : 14  |  Issue : 4  |  Page : 431--432

Case report - antepartum diagnosis of placenta accreta


DJ Thakrar, KM Shah, D Parikh, FA Shah, AN Dave, VB Patel 
 Department of Radiology & Imaging, L.G.General Hospital, Smt. N.H.L Municipal medical college, Ahmedabad - 380 009, India

Correspondence Address:
F A Shah
Assistant professor of radiology «SQ»NIRAMAY«SQ» 8, Prabhat soceity Besides suvidha shopping centre, Paldi Ahhmedabad-380007
India




How to cite this article:
Thakrar D J, Shah K M, Parikh D, Shah F A, Dave A N, Patel V B. Case report - antepartum diagnosis of placenta accreta.Indian J Radiol Imaging 2004;14:431-432


How to cite this URL:
Thakrar D J, Shah K M, Parikh D, Shah F A, Dave A N, Patel V B. Case report - antepartum diagnosis of placenta accreta. Indian J Radiol Imaging [serial online] 2004 [cited 2019 Oct 18 ];14:431-432
Available from: http://www.ijri.org/text.asp?2004/14/4/431/28689


Full Text

 INTRODUCTION



Placenta accreta is a condition characterized by abnormal adherence, of either in whole or a part of placenta to the uterine wall.

30% of cases of placenta previa are associated with placenta accreta[3]. It is a serious abnormality with increased maternal morbidity and mortality and requires obstretic hysterectomy[3].

Antepartum diagnosis of this condition helps the obstetrician to demarcate areas of placenta that are adherent to uterine myometrium. Knowing this the obstetrician can plan the management accordingly and can demarcate the areas of placenta that require resection.

We came across a case of placenta accreata which was diagnosed an routine antenatal US.

 CASE REPORT



A 30 year old female presented with history of six months amenorrhoea and past history of two lower segement cesearion section (LSCS).

Antenatal US was performed at six months amenorrhoea and again repeated at monthly intervals till full term

 USG



On antenatal US findings were; placenta previa with placental tissue covering the internal os [Figure 1]. Multiple intraplacental lakes were seen likely to be as a result of abberent blood flow in absence of normal decidua [Figure1],[Figure 2].Absent decidual interface between placenta and myometrium at the level of villous penetration, at the site of previous LSCS. Thinning and distortion of the Uterine serosa bladder wall complex

[Figure 3].The placental tissue was thicker and more echoreflective as compared to

normal placenta.

 CONFORMATION OF DIAGNOSIS



Elective LSCS was performed at full term. The per-operative findings showed placenta previa with the placenta adherent to the myometrium at the site of scar of previous LSCS. There was inability of complete separation of placenta with profuse blood loss from the site of placenta accreta; for which subtotal hysterectomy was performed with ligation of both internal iliac arteries.

 DISCUSSION



Columbus first coined the term placenta which meant a circular cake in latin. When the decidua basalis is partially or completely absent due to; previous LSCS, uterine surgery, curretage, sepsis or fibroid; which are the predisposing factor; these lead to myometrial invasion by the villi, at the site where the decidua basalis is absent.

This condition is subdivided into :

placenta accreta:- placenta simply attached to the myometrium.placenta increta:- placental invasion deep into the myometrium.placenta percreta: placental penetration along the entire thickness of uterine wall.

USG criteria for diagnosis of placenta accreta

Absence of severe thinning of hypoechoic myometrium between the placenta and uterine serosa - bladder wall complexThinning irregularity and disruption of linear hyperechoic uterine serosa - bladder wall complexExtension of tissue of placental echogenicity beyond uterine serosa.

References

1FROM: Ultrasound in Obstretics and Gynaecology. Authors: Meire-Cosgrove- Dewberry-Wilde. Chp:-Placenta and cord.Churchill liveinstone 1993. Pages 442-443.
2Hoffman-Tretin J C, Koenigsbergm, Rubin A, Anyaegbunam A: Additional sonographic observations. J Ultrasuond med 11:29, 1992
3Finberg H. J., Williams J W, Prospective sonographic diagnosis in patient with placenta previa and prior CS-J Ultrasuond med 11:333, 1992.