A comparative study of ultrasonography versus magnetic resonance imaging in the diagnosis of abnormally adherent low lying placenta

Authors

  • Mohd. Ashraf Department of Obstetrics and Gynaecology, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Humera Noor Department of Obstetrics and Gynaecology, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Asima Afzal Department of Obstetrics and Gynaecology, Government Medical College, Srinagar, Jammu and Kashmir, India
  • Irfana Rasool Department of Medical Health, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20161299

Keywords:

Placenta, Ultrasonography, MRI, Caesarean

Abstract

Background: When placenta is implanted partially or completely over the lower uterine segment it is called as placenta previa. Abnormalities associated with placenta previa include placenta accreta, placenta increta and placenta percreta. Prenatal diagnosis of placental abnormalities was earlier difficult but now a day’s placentography is done using gray scale ultrasonography and more recently magnetic resonance imaging with or without gadolinium has been explored as a modality to optimize diagnostic accuracy. The objective of this study was to compare the effectiveness of ultrasonography and magnetic resonance imaging in diagnosis of placental abnormalities in patients having low lying placenta. The Design of this study was a prospective study conducted in a tertiary care hospital.

Methods: This study was conducted on 100 admitted pregnant females with gestational age 30-37 weeks with low lying placenta (previa), haemodynamically stable and having past history of uterine surgeries like caesarean delivery, dilatation and curettage and myomectomy. After confirming gestational age and low lying placenta on Ultrasonography, the detailed USG study was done. All the patients in the study group underwent MRI which was performed without contrast.

Results: Among 100 cases, most of the patients were in the age group of 26-30 (52%), the least common age group was 20-25 (4%). Out of 100 studied cases 29 were gravid two with 20.6% associated PAD, 34 were Gravida three with 29.4 % PAD, 21 were gravid four with 23.8% PAD. Among 100 studied cases, dilatation and curettage was absent in 37 cases, out of that 22 had undergone one caesarean section, 13 had undergone two caesarean section and 2 cases had undergone three caesarean section. USG showing sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 53.3, 90.0, 69.6 and 81.8 % respectively. X2=22.266 and p=0.00. MRI showing sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 73.3, 91.4, 78.6 and 8.89 % respectively.X2=43.689 and p=0.001.

Conclusions: Prenatal diagnosis is a key factor in optimizing the counseling, treatment and outcome of patients with placental adhesive disorder. Any women with placenta previa and previous uterine surgery should undergo careful imaging to assess the presence of placental adhesive disorder. Magnetic resonance imaging appears better diagnostic aid as compared to ultrasonography in diagnosing placental adhesive disorder.

References

Thakar DJ, Shah KM, Parikh D, Shah FA, Dave AN, Patel VB. Case report-Antepartum diagnosis of placenta accreta. Ind J Radiol Imag. 2004;14(4):431-2.

Dutta DC. Placental development; text book of obstetrics. 6th ed. New cental book agency Calcutta; 2004:3:28.

Cunningham G, Leveno KL, Bloom SL, Hauth JC, Gilstrap LC, Wenstrom KD. William obstetrics: placenta previa, incidence, 22nd ed. New York, McGraw Hill; 2005:27:820.

Dutta DC . Placenta previa, incidence: 6th ed. New cental book agency Calcutta; 2004:18:243.

Dwyer BK, Victoria B, Lan T, Rao A, Caroll I, Barth R: prenatal diagnosis of placenta accreta, sonography or Magnetic resonance imaging. J Ultrasound Med. 2008;27(9):1275-81.

Angstemonn T, Gard G, Harrington T. Surgical management of placenta accreta: a cohort series and suggested approach. Am J of Obstet Gynecol. 2010;202(1):38:1-9.

William CB, Corteville JE. Placenta accreta: spectrum of US and MR imaging Finding. Radiographics. 2008;28(7):1905-16.

Masselli G, Brunelli R, Casciani E. Magnetic resonance imaging in the evaluation of placental adhesive disorder: correlation with color Doppler ultrasound. Eur Radio. 2008;18:1292-9.

Breen JL, Neubecker R, Gregori CA. Placenta accreta, increta and percreta. A survey of 40 cases. Obstet Gynecol. 1977;49;43-7.

Lea T, Josip D, Marcela I. Obstetric risk factors associated with placenta previa development: case-control study. Croat Med J. 2003;44:728-33.

Clark SL, Kooning PP, Phelan JP. Placenta previa/accreta and prior caesarean section. Obstet Gynecol. 1985;66:89-92.

Warshak CR, Eskander R, Hull AD. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstetrics Gynecol. 2006;108:573-81.

Downloads

Published

2017-01-04

Issue

Section

Original Research Articles