• Giuseppe Cali, Francesco Forlani, Ilan Timor-Trisch, José Palacios-Jaraquemada, Francesca Foti, Gabriella Minneci, Maria E Flacco, Lamberto Manzoli, Alessandra Familiari, Giorgio Pagani, Giovanni Scambia, and Francesco D'Antonio.
• Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy.
• Acta Obstet Gynecol Scand. 2018 Oct 1; 97 (10): 1219-1227.

IntroductionThe aim of this study was to assess the diagnostic accuracy of ultrasound in detecting the depth of abnormally invasive placenta in women at risk.Material And MethodsProspective longitudinal study including women with placenta previa and at least one prior cesarean delivery or uterine surgery. Depth of abnormally invasive placenta was defined as the degree of trophoblastic invasion through the myometrium and was assessed with histopathological analysis. The ultrasound signs explored were: loss of clear zone, placental lacunae, bladder wall interruption, uterovesical hypervascularity, and increased vascularity in the parametrial region.ResultsIn all, 210 women were included in the analysis. When using at least one sign, ultrasound had an overall sensitivity of 100% (95% CI 96.5-100) and overall specificity of 61.9 (95% CI 51.9-71.2) for all types of abnormally invasive placenta. Using two ultrasound signs increased the diagnostic accuracy in terms of specificity (100%, 95% CI 96.5-100) but did not affect sensitivity. When stratifying the analysis according to the depth of placental invasion, using at least one sign had a sensitivity of 100% (95% CI 93.7-100) and 100% (95% CI 92.6-100) for placenta accreta/increta and percreta, respectively. Using three ultrasound signs improved the detection rate for placenta percreta with a sensitivity of 100% (95% CI 92.6-100) and a specificity of 77.2% (95% CI 69.9-83.4).ConclusionUltrasound has a high diagnostic accuracy in detecting the depth of placental invasion when applied to a population with specific risk factors for anomalies such as placenta previa and prior cesarean delivery or uterine surgery.© 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

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