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Morbidly Adherent Placenta
Anne M. Kennedy, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Abnormal penetration of placental tissue beyond endometrial lining of uterus
                • 3 stages identified on histopathology
                  • 75-80% placenta accreta: Placenta attached to myometrium without muscular invasion
                  • 15% placenta increta: Chorionic villi (CV) invade myometrium
                  • 5% placenta percreta: CV penetrate serosa ± invade adjacent structures
                    • May invade bladder, rectum, and parametrium
              • Clinically similar and imaging cannot differentiate, therefore newer terms used to describe spectrum include
                • Morbidly adherent placentation (MAP), placental adhesive disorders, abnormally invasive placenta

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Microscopic Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Image Interpretation Pearls

                                    • Reporting Tips

                                      Selected References

                                      1. Rac MW et al: Sonographic Findings of Morbidly Adherent Placenta in the First Trimester. J Ultrasound Med. 35(2):263-9, 2016
                                      2. Bailit JL et al: Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 125(3):683-9, 2015
                                      3. Collins SL et al: Proposal for standardised ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. ePub, 2015
                                      4. D'Antonio F et al: Counseling in fetal medicine: evidence based answer to clinical questions on morbidly adherent placenta. Ultrasound Obstet Gynecol. ePub, 2015
                                      5. Gilboa Y et al: A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta. J Ultrasound Med. 34(4):561-7, 2015
                                      6. Rahaim NS et al: The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clin Radiol. 70(9):917-25, 2015
                                      7. Silver RM et al: Center of excellence for placenta accreta. Am J Obstet Gynecol. 212(5):561-8, 2015
                                      8. Teixidor Viñas M et al: Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol. 46(3):350-5, 2015
                                      9. Bowman ZS et al: Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol. 31(9):799-804, 2014
                                      10. Bowman ZS et al: Risk factors for unscheduled delivery in patients with placenta accreta. Am J Obstet Gynecol. 210(3):241.e1-6, 2014
                                      11. D'Antonio F et al: Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 44(1):8-16, 2014
                                      12. Abuhamad A: Morbidly adherent placenta. Semin Perinatol. 37(5):359-64, 2013
                                      13. D'Antonio F et al: Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 42(5):509-17, 2013
                                      14. Hoffman MS et al: Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol. 202(6):628, 2010
                                      15. Robinson BK et al: Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol. 116(4):835-42, 2010
                                      16. Sivan E et al: Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy? Am J Perinatol. 27(6):455-61, 2010
                                      17. Warshak CR et al: Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 115(1):65-9, 2010
                                      18. Elsayes KM et al: Imaging of the placenta: a multimodality pictorial review. Radiographics. 29(5):1371-91, 2009
                                      19. Merz W et al: Diagnosis, treatment and application of color Doppler in conservative management of abnormally adherent placenta. Ultraschall Med. 30(6):571-6, 2009
                                      20. Baughman WC et al: Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 28(7):1905-16, 2008
                                      21. Dwyer BK et al: Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med. 27(9):1275-81, 2008
                                      22. Masselli G et al: Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol. 18(6):1292-9, 2008
                                      23. Wong HS et al: Evaluation of sonographic diagnostic criteria for placenta accreta. J Clin Ultrasound. 36(9):551-9, 2008
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Definitions

                                                  • Abnormal penetration of placental tissue beyond endometrial lining of uterus
                                                    • 3 stages identified on histopathology
                                                      • 75-80% placenta accreta: Placenta attached to myometrium without muscular invasion
                                                      • 15% placenta increta: Chorionic villi (CV) invade myometrium
                                                      • 5% placenta percreta: CV penetrate serosa ± invade adjacent structures
                                                        • May invade bladder, rectum, and parametrium
                                                  • Clinically similar and imaging cannot differentiate, therefore newer terms used to describe spectrum include
                                                    • Morbidly adherent placentation (MAP), placental adhesive disorders, abnormally invasive placenta

                                                IMAGING

                                                • General Features

                                                  • Ultrasonographic Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Microscopic Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Image Interpretation Pearls

                                                                        • Reporting Tips

                                                                          Selected References

                                                                          1. Rac MW et al: Sonographic Findings of Morbidly Adherent Placenta in the First Trimester. J Ultrasound Med. 35(2):263-9, 2016
                                                                          2. Bailit JL et al: Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 125(3):683-9, 2015
                                                                          3. Collins SL et al: Proposal for standardised ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. ePub, 2015
                                                                          4. D'Antonio F et al: Counseling in fetal medicine: evidence based answer to clinical questions on morbidly adherent placenta. Ultrasound Obstet Gynecol. ePub, 2015
                                                                          5. Gilboa Y et al: A novel sonographic scoring system for antenatal risk assessment of obstetric complications in suspected morbidly adherent placenta. J Ultrasound Med. 34(4):561-7, 2015
                                                                          6. Rahaim NS et al: The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clin Radiol. 70(9):917-25, 2015
                                                                          7. Silver RM et al: Center of excellence for placenta accreta. Am J Obstet Gynecol. 212(5):561-8, 2015
                                                                          8. Teixidor Viñas M et al: Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: a cohort study comparing outcomes before and after introduction of the Triple-P procedure. Ultrasound Obstet Gynecol. 46(3):350-5, 2015
                                                                          9. Bowman ZS et al: Risk factors for placenta accreta: a large prospective cohort. Am J Perinatol. 31(9):799-804, 2014
                                                                          10. Bowman ZS et al: Risk factors for unscheduled delivery in patients with placenta accreta. Am J Obstet Gynecol. 210(3):241.e1-6, 2014
                                                                          11. D'Antonio F et al: Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 44(1):8-16, 2014
                                                                          12. Abuhamad A: Morbidly adherent placenta. Semin Perinatol. 37(5):359-64, 2013
                                                                          13. D'Antonio F et al: Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 42(5):509-17, 2013
                                                                          14. Hoffman MS et al: Morbidity associated with nonemergent hysterectomy for placenta accreta. Am J Obstet Gynecol. 202(6):628, 2010
                                                                          15. Robinson BK et al: Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol. 116(4):835-42, 2010
                                                                          16. Sivan E et al: Prophylactic pelvic artery catheterization and embolization in women with placenta accreta: can it prevent cesarean hysterectomy? Am J Perinatol. 27(6):455-61, 2010
                                                                          17. Warshak CR et al: Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 115(1):65-9, 2010
                                                                          18. Elsayes KM et al: Imaging of the placenta: a multimodality pictorial review. Radiographics. 29(5):1371-91, 2009
                                                                          19. Merz W et al: Diagnosis, treatment and application of color Doppler in conservative management of abnormally adherent placenta. Ultraschall Med. 30(6):571-6, 2009
                                                                          20. Baughman WC et al: Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 28(7):1905-16, 2008
                                                                          21. Dwyer BK et al: Prenatal diagnosis of placenta accreta: sonography or magnetic resonance imaging? J Ultrasound Med. 27(9):1275-81, 2008
                                                                          22. Masselli G et al: Magnetic resonance imaging in the evaluation of placental adhesive disorders: correlation with color Doppler ultrasound. Eur Radiol. 18(6):1292-9, 2008
                                                                          23. Wong HS et al: Evaluation of sonographic diagnostic criteria for placenta accreta. J Clin Ultrasound. 36(9):551-9, 2008