Sonographic finDings of morbidly adherent placenta in the first trimester

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18 Citations (Scopus)

Abstract

Objectives-The purpose of this study was to evaluate the association between firsttrimester 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.

Original languageEnglish (US)
Pages (from-to)263-269
Number of pages7
JournalJournal of Ultrasound in Medicine
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

First Pregnancy Trimester
Placenta
Placenta Previa
Ultrasonography
Multivariate Analysis
Gestational Sac
Decidua
Placentation
Third Pregnancy Trimester
Hysterectomy
ROC Curve
Urinary Bladder
Confidence Intervals

Keywords

  • First trimester
  • Morbidly adherent placenta
  • Obstetric ultrasound
  • Sonography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

@article{8160b6abd1d244438f93ced2978def2d,
title = "Sonographic finDings of morbidly adherent placenta in the first trimester",
abstract = "Objectives-The purpose of this study was to evaluate the association between firsttrimester 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.",
keywords = "First trimester, Morbidly adherent placenta, Obstetric ultrasound, Sonography",
author = "Rac, {Martha W F} and Elysia Moschos and Wells, {C. Edward} and McIntire, {Donald D.} and Dashe, {JoDi S.} and Twickler, {DIane M.}",
year = "2016",
month = "2",
day = "1",
doi = "10.7863/ultra.15.03020",
language = "English (US)",
volume = "35",
pages = "263--269",
journal = "Journal of Ultrasound in Medicine",
issn = "0278-4297",
publisher = "American Institute of Ultrasound in Medicine",
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TY - JOUR

T1 - Sonographic finDings of morbidly adherent placenta in the first trimester

AU - Rac, Martha W F

AU - Moschos, Elysia

AU - Wells, C. Edward

AU - McIntire, Donald D.

AU - Dashe, JoDi S.

AU - Twickler, DIane M.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Objectives-The purpose of this study was to evaluate the association between firsttrimester 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.

AB - Objectives-The purpose of this study was to evaluate the association between firsttrimester 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.

KW - First trimester

KW - Morbidly adherent placenta

KW - Obstetric ultrasound

KW - Sonography

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