morbidly adherent placenta (for apan39)
TRANSCRIPT
Case Report
Prenatal Ultrasound Diagnosis
Chang Bing Show ChwanMemorial Hospital
Li-hsun Chen
Morbidly
Adherent
Placenta
Miss Chen35Y/o, negative for major systemic disease and past history.Habits of smoking and no alcohol drinking.G3P1A1
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Case 1
G1: scheduled cesarean section for malpresentation (2012 Oct.) G2: artificial abortion with RU486 (2013 Mar.)G3: LMP 20140510 EDC 20150213Regular antenatal visit our clinic.
Sonographic Image at 21st week
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BP
Sonographic Image at 21st week
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Sonographic Image at 21st week
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Placenta
Sonographic Image at 21st week
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Pregnancy at 32nd week,she got massive vaginal bleeding and admitted intothe ward.
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Sonographic Image at 32nd week
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3D Sonographic Image at 32nd week
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BP
Placenta previa with MAP
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Four days later, she was transferred to the terminal center for delivery and placed balloon catheterization before cesarean section.
Leave the placenta in situ
Miss Ke39Y/o, negative for major systemic disease and past history.G1P0
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Case 2
LMP 201405102 EDC 20150214Regular antenatal visit our clinic.
Sonographic Image at 32nd week
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Sonographic Image at 32nd week
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Placenta previa without MAP
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Pregnancy at 34th week,she got massive vaginal bleeding and caserean section .
Morbidly Adherent Placenta
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2D ultrasonography
2D sonographic features
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Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irregular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
2D sonographic features
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Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irregular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
Loss of retroplacental hypoecoic area
- reflects loss of basal decidua and retroplacental vascular bed
- Se, 50%, PV 55%
2D sonographic features
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Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irrrgular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
Disruption utero-vesical serosa
Extrauterine placental parenchyma
Loss of retroplacental hypoecoic area
- reflects loss of basal decidua and retroplacental vascular bed
- Se, 50%, PV 52%
Progressive thinning of retroplacental myometrium
- If < 1mm
- Se 85%, PV 80%
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2D color doppler features
Diffuse or focal lacunar flow
Hypervascularity of serosa-bladder interface
Markedly dilated vessels over peripheral subplacental zone
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2D color doppler features
Diffuse or focal lacunar flow
Hypervascularity of serosa-bladder interface
Markedly dilated vessels over peripheral subplacental zone
Vascular lakes with turbulent flow (PSV > 15 cm/s)
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Irregular intraplacental vascularization with tortuous confluent vessels crossing placental width.
Hypervascularityof uterine serosa–bladder wall interface.
3D ultrasonography
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Uterine bulging Heterogenous
signal intensity within placenta
Dark intraplacentalbands on T2 weighted imaging
MRI
Conclusion
TAS+ Doppler
TVS
MRI
Thanks
for your attentions
Chang Bing Show ChwanMemorial Hospital
Li-hsun Chen
Thanks
for your attentions