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Erschienen in:
16.07.2019 | Aberrant Placentation: Contemporary Management of Placenta Accreta (E Jauniaux, Section Editor)
Prenatal Ultrasound Imaging for Placenta Accreta Spectrum (PAS): a Practical Guide
Erschienen in: Current Obstetrics and Gynecology Reports | Ausgabe 3/2019
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Purpose of Review
Placenta accreta spectrum (PAS) is a rare pregnancy complication with an increasing incidence worldwide. PAS can cause serious maternal morbidity and even mortality at delivery. Ultrasound (US) is an excellent imaging modality for the diagnosis of PAS, but it must be used correctly and there is little standardised training in placental imaging available. The aim of this paper is to discuss US screening for PAS and provide practical advice on its use for antenatal diagnosis.
Recent Findings
Screening for PAS in a high-risk population (history of previous caesarean delivery (CD) and an anterior low-lying/praevia placenta) is possible in well-trained hands with high sensitivity and specificity. This can be performed in the first trimester but usually occurs around 24–28 weeks after the routine anomaly US. A detailed examination of the placental bed using the US signs defined by EW-AIP with an adequately filled bladder enables the operator to produce a detailed report fully outlining the anticipated findings at delivery. This facilitates an appropriate multi-disciplinary team (MDT) approach which is the goal for optimal PAS management.
Summary
Women with a history of previous CD and an anterior low-lying/praevia placenta need a detailed examination of the placenta by an experienced operator. The US examination should be undertaken systematically, and the risk factors and US signs reported in a way which is useful to the MDT.