• Ayman Hussien Shaamash, Mehad H AlQasem, Deama S Al Ghamdi, Ahmed A Mahfouz, and Mamdoh A Eskandar.
• From the Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia.
• Ann Saudi Med. 2023 Jul 1; 43 (4): 219217219-217.

BackgroundAntenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis.ObjectivesEvaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP.DesignA 10-year retrospective cohort study.SettingTertiary care hospital.Patients And MethodsWe report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US).Main Outcome MeasuresRisk factors for PAS in major PP and maternal complications.Sample Size299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding.ConclusionMRI may be a valuable adjunct in the evaluation of PAS in major PP; as a complement, but not substitute US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or deep/extra-uterine extension on US.LimitationSingle center, small sample size, lack of complete histopathological diagnosis.Conflict Of InterestNone.

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