INTRODUCTION: In cases of placenta accreta spectrum, a precise antenatal diagnosis of the suspected degree of invasion is essential for the planning of individual management strategies at delivery. The aim of this work was to evaluate the respective performances of ultrasonography and magnetic resonance imaging for the antenatal assessment of the severity of placenta accreta spectrum disorders included in the database. The secondary objective was to identify descriptors related to the severity of placenta accreta spectrum disorders. MATERIAL AND METHODS: All the cases included in the database for which antenatal imaging data were available were analyzed. The rates of occurrence of each ultrasound and magnetic resonance imaging descriptor were reported and compared between the Group "Accreta-Increta" (FIGO grades 1 & 2) and the Group "Percreta" (FIGO grade 3). RESULTS: Antenatal imaging data were available for 347 women (347/442, 78.5%), of which 105 were included in the Group "Accreta - Increta" (105/347, 30.2%) and 213 (213/347, 61.4%) in the Group "Percreta". Magnetic resonance imaging was performed in addition to ultrasound in 135 women (135/347, 38.9%). After adjustment for all ultrasound descriptors in multivariate analysis, only the presence of a bladder wall interruption was associated with a significant higher risk of percreta (Odds ratio 3.23, Confidence interval 1.33-7.79). No magnetic resonance imaging sign was significantly correlated with the degree of severity. CONCLUSIONS: The performance of ultrasound and magnetic resonance imaging to discriminate mild from severe placenta accreta spectrum disorders is very poor. To date, the benefit of additional magnetic resonance imaging has not been demonstrated.

Charité Universitätsmedizin Berlin corporate member of Freie Universität Berlin Humboldt Universität zu Berlin Berlin Germany

Department of Gynecological Oncology Erasmus MC Cancer center Rotterdam The Netherlands

Department of Obstetrics and Gynecology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Obstetrics and Gynecology Bordeaux University Hospital Bordeaux France

Department of Obstetrics and Gynecology Buergerhospital Dr Senckenberg Foundation Frankfurt Germany

Department of Obstetrics and Gynecology Fetomaternal Medical Center Helsinki University Hospital and University of Helsinki Helsinki Finland

Department of Obstetrics and Gynecology University Hospital of the Goethe University of Frankfurt Frankfurt Germany

Department of Obstetrics Berlin Institute of Health Berlin Germany

Department of Obstetrics Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Division of Obstetrics and Feto Maternal Medicine Department of Obstetrics and Gynecology Medical University of Vienna Vienna Austria

Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK and the Fetal Medicine Unit John Radcliffe Hospital Oxford UK

Praenatal Zuerich and Medical Faculty Heinrich Heine University Duesseldorf Germany

Women's Division Nancy Regional University Hospital Inserm Université de Lorraine Nancy France

See more in PubMed

Jauniaux E, Alfirevic Z, Bhide AG, et al. Placenta praevia and placenta accreta: diagnosis and management. BJOG. 2019;126(1):e1‐e48. PubMed

Chantraine F, Braun T, Gonser M, Henrich W, Tutschek B. Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity. Acta Obstet Gynecol Scand. 2013;92:439‐444. PubMed

Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand. 2011;90:1140‐1146. PubMed

Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population‐based descriptive study. BJOG. 2014;121:62‐70; discussion 70–71. PubMed PMC

Bailit JL, Grobman WA, Rice MM, et al. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 2015;125:683‐689. PubMed PMC

Thurn L, Lindqvist PG, Jakobsson M, et al. Abnormally invasive placenta‐prevalence, risk factors and antenatal suspicion: results from a large population‐based pregnancy cohort study in the Nordic countries. BJOG. 2016;123:1348‐1355. PubMed

Jauniaux E, Bhide A, Kennedy A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018;140:274‐280. PubMed

Morel O, Collins SL, Uzan‐Augui J, et al. A proposal for standardized magnetic resonance imaging (MRI) descriptors of abnormally invasive placenta (AIP) ‐ From the International Society for AIP. Diagn Interv Imaging. 2019;100:319‐325. PubMed

Collins SL, Ashcroft A, Braun T, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47:271‐275. PubMed

Braun T, van Beekhuizen HJ, Morlando M, Morel O, Stefanovic V, IS‐PAS . Developing a database for multicenter evaluation of Placenta Accreta Spectrum. Acta Obstet Gynecol Scand. 2021;100(Suppl. 1):7–11. PubMed

Collins SL, Stevenson GN, Al‐Khan A, et al. Three‐Dimensional Power Doppler Ultrasonography for Diagnosing Abnormally Invasive Placenta and Quantifying the Risk. Obstet Gynecol. 2015;126:645‐653. PubMed PMC

Collins SL, Alemdar B, van Beekhuizen HJ, et al. Evidence‐based guidelines for the management of abnormally invasive placenta: recommendations from the International Society for Abnormally Invasive Placenta. Am J Obstet Gynecol. 2019;220:511‐526. PubMed

Jauniaux E, Ayres‐de‐Campos D, Langhoff‐Roos J, Fox KA, Collins S. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 2019;146:20‐24. PubMed

Pagani G, Cali G, Acharya G, et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta‐analysis. Acta Obstet Gynecol Scand. 2018;97:25‐37. PubMed

Jauniaux E, Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta‐analysis. Am J Obstet Gynecol. 2017;217:27‐36. PubMed

Einerson BD, Rodriguez CE, Kennedy AM, Woodward PJ, Donnelly MA, Silver RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol. 2018;218:618.e1‐618.e7. PubMed

Emergency delivery in case of suspected placenta accreta spectrum: Can it be predicted?