Ultrasound diagnosis of placenta accreta: yes we can

The three forms of morbidly adherent placenta (MAP): placenta accreta, increta and percreta, present a significant obstetric challenge, at times resulting in life-threatening bleeding and/or peripartum hysterectomy. The increasing rate of Cesarean section (CS) deliveries correlates with the rising incidence of MAP. It occurs in 9.3% of women with placenta previa and in 0.04% of women without placenta previa4, the risk being 5% in placenta previa cases with no previous uterine surgery, 24% in those with a previous CS and 67% in those with four previous CS. In addition to previous CS, a maternal age over 35years, multiparity, previous curettage and pla- centa previa are risk factors associated with MAP. This condition is often diagnosed during CS, upon placental removal, with unfavorable maternal outcome: attempts to remove the placenta can cause severe uterine bleeding. An accurate prenatal diagnosis is required to reduce the risk of maternal/fetal morbidity and mortality. Ultrasonography is used routinely for diagnosis of MAP, although diagnostic criteria and accuracy are still subject to debate. Magnetic resonance imaging (MRI) can be helpful when the placenta is difficult to visualize on ultrasound due to the patient’s body habitus or to a posterior location of the placenta.

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