Prediction of adherent placenta in pregnancy with placenta previa using ultrasonography and magnetic resonance imaging.
OBJECTIVE
Adherent placenta is a life-threatening condition in pregnancy, and is often complicated by placenta previa. The aim of this prospective study was to determine prenatal imaging findings that predict the presence of adherent placenta in pregnancies with placenta previa.


METHODS
The study included 58 consecutive pregnant women with placenta previa who underwent both ultrasonography and magnetic resonance imaging prenatally. Ultrasonographic findings of anterior placental location, grade 2 or higher placental lacunae (PL≥G2), loss of retroplacental hypoechoic clear zone (LCZ) and the presence of turbulent blood flow in the arteries were evaluated, in addition to MRI findings. Forty-three women underwent cesarean section alone; 15 women with adherent placenta underwent cesarean section followed by hysterectomy with pathological examination. To determine imaging findings that predict adherent placenta, univariate and multivariate logistic regression analyses were performed.


RESULTS
Univariate logistic regression analyses demonstrated that anterior placental location, PL≥G2, LCZ, and MRI were associated with the presence of adherent placenta. Multivariate analyses revealed that LCZ (p<0.01, odds ratio 15.6, 95%CI 2.1-114.6) was a single significant predictor of adherent placenta in women with placenta previa.


CONCLUSIONS
This prospective study demonstrated for the first time that US findings, especially LCZ, might be useful for identifying patients at high risk for adherent placenta among pregnant women with placenta previa.
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Kenji
K
Tanimura
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Yui
Y
Yamasaki
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Yasuhiko
Y
Ebina
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Masashi
M
Deguchi
Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
Yoshiko
Y
Ueno
Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
Kazuhiro
K
Kitajima
Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan. Electronic address: yhideto@med.kobe-u.ac.jp.
Hideto
H
Yamada
D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D016017:Odds Ratio; D010923:Placenta Previa / Q000000981:diagnostic imaging* / Q000473:pathology*; D018457:Placenta, Retained / Q000000981:diagnostic imaging* / Q000473:pathology*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal
Adherent placenta; Magnetic resonance imaging; Placenta previa; Prenatal diagnosis; Ultrasonography