Skip to main content

Cervical varicosities may predict placenta accreta in posterior placenta previa: a magnetic resonance imaging study

Archives of Gynecology and Obstetrics volume 296, pages 731–736 (2017)Cite this article

Abstract

Purpose

The aim of this study was to prenatally predict placenta accreta in posterior placenta previa using magnetic resonance imaging (MRI).

Methods

This retrospective study was approved by the Institutional Review Board of our hospital. We identified 81 patients with singleton pregnancy who had undergone cesarean section due to posterior placenta previa at our hospital between January 2012 and December 2016. We calculated the sensitivity and specificity of several well-known findings, and of cervical varicosities quantified using magnetic resonance imaging, in predicting placenta accreta in posterior placenta previa. To quantify cervical varicosities, we calculated the A/B ratio, where “A” was the minimum distance from the most dorsal cervical varicosity to the deciduous placenta, and “B” was the minimum distance from the most dorsal cervical varicosity to the amniotic placenta. The appropriate cut-off value of the A/B ratio was determined using a receiver operating characteristic (ROC) curve.

Results

Three patients (3.7%) were diagnosed as having placenta accreta. The sensitivity and specificity of the well-known findings were 0 and 97.4%, respectively. Furthermore, the A/B ratio ranged from 0.02 to 0.79. ROC curve analysis revealed that the area under the combined placenta accreta and A/B ratio curve was 0.96. When the cutoff value of the A/B ratio was set 0.18, the sensitivity and specificity were 100 and 91%, respectively.

Conclusion

It was difficult to diagnose placenta accreta in the posterior placenta previa using the well-known findings. The quantification of cervical varicosities could effectively predict placenta accreta.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Cresswell JA, Ronsmans C, Calvert C, Filippi V (2013) Prevalence of placenta praevia by world region: a systematic review and meta-analysis. Trop Med Int Health 18:712–724

    Article  PubMed  Google Scholar 

  2. Miller DA, Chollet JA, Goodwin TM (1997) Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol 177:210–214

    CAS  Article  PubMed  Google Scholar 

  3. Saleh Gargari S, Seify Z, Haghighi L, Khoshnood Shariati M, Mirzamoradi M (2016) Risk factors and consequent outcomes of placenta previa: report from a referral center. Acta Med Iran 54:713–717

    PubMed  Google Scholar 

  4. Ananth CV, Smulian JC, Vintzileos AM (2003) The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol 188:1299–1304

    Article  PubMed  Google Scholar 

  5. Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH (2005) Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol 193:1045–1049

    Article  PubMed  Google Scholar 

  6. O’Brien JM, Barton JR, Donaldson ES (1996) The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 175:1632–1638

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  8. Eller AG, Porter TF, Soisson P, Silver RM (2009) Optimal management strategies for placenta accreta. BJOG 116:648–654

    CAS  Article  PubMed  Google Scholar 

  9. Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF, Moore TR, Resnik R (2010) Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol 115:65–69

    Article  PubMed  Google Scholar 

  10. Baughman WC, Corteville JE, Shah RR (2008) Placenta accreta: spectrum of US and MR imaging findings. Radiographics 28:1905–1916

    Article  PubMed  Google Scholar 

  11. Royal College of Obstetricians and Gynaecologists Green Top Guideline 27. (2017) Placental praevia, placenta praevia accreta and vasa praevia: diagnosis and management. https://www.rcog.org.uk/en/guidelines-research-services/guidelines. Accessed 6 March, 2017

  12. D’Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L, Bhide A (2014) Prenatal identification of invasive placentation using magnetic resonance imaging: systematic review and meta-analysis. Ultrasound Obstet Gynecol 44:8–16

    Article  PubMed  Google Scholar 

  13. Chou MM, Ho ES, Lee YH (2000) Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol 15:28–35

    CAS  Article  PubMed  Google Scholar 

  14. Evans CJ, Allan PL, Lee AJ, Bradbury AW, Ruckley CV, Fowkes FG (1998) Prevalence of venous reflux in the general population on duplex scanning: the Edinburgh vein study. J Vasc Surg 28:767–776

    CAS  Article  PubMed  Google Scholar 

  15. O’Brien B, Smoleneic J (2013) Cervical varicosities and placenta praevia. Aust N Z J Obstet Gynaecol 53:451–454

    PubMed  Google Scholar 

  16. Hasegawa J, Matsuoka R, Ichizuka K, Mimura T, Sekizawa A, Farina A, Okai T (2009) Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa. Ultrasound Obstet Gynecol 34:80–84

    CAS  Article  PubMed  Google Scholar 

  17. Oyelese Y, Smulian JC (2006) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107:927–941

    Article  PubMed  Google Scholar 

  18. Mansour SM, Elkhayat WM (2011) Placenta previa-accreta. Do we need MR imaging? Egypt J Radiol Nucl Med 42:433–443

    Article  Google Scholar 

  19. Faul F, Erdfelder E, Lang AG, Buchner AG (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  20. Alamo L, Anaye A, Rey J, Denys A, Bongartz G, Terraz S, Artemisia S, Meuli R, Schmidt S (2013) Detection of suspected placental invasion by MRI: do the results depend on observer experience? Eur J Radiol 82:e51–e57. doi:10.1016/j.ejrad.2012.08.022

    Article  PubMed  Google Scholar 

  21. Shweel MAG, El Ameen NF, Ibrahiem MA, Kotib A (2012) Placenta accreta in women with prior uterine surgery: diagnostic accuracy of Doppler ultrasonography and MRI. Egypt J Radiol Nucl Med 43:473–480

    Article  Google Scholar 

  22. Lim PS, Greenberg M, Edelson MI, Bell KA, Edmonds PR, Mackey AM (2011) Utility of ultrasound and MRI in prenatal diagnosis of placenta accreta: a pilot study. Am J Roentgenol 197:1506–1513

    Article  Google Scholar 

  23. Derman AY, Nikac V, Haberman S, Zelenko N, Opsha O, Flyer M (2011) MRI of placenta accreta: a new imaging perspective. Am J Roentgenol 197:1514–1521

    Article  Google Scholar 

  24. Woodring TC, Klauser CK, Bofill JA, Martin RW, Morrison JC (2011) Prediction of placenta accreta by ultrasonography and color Doppler imaging. J Matern Fetal Neonatal Med 24:118–121

    Article  PubMed  Google Scholar 

  25. Hannon T, Innes BA, Lash GE, Bulmer JN, Robson SC (2012) Effects of local decidua on trophoblast invasion and spiral artery remodeling in focal placenta creta—an immunohistochemical study. Placenta 33:998–1004

    CAS  Article  PubMed  Google Scholar 

  26. Mégier P, Gorin V, Desroches A (1999) Ultrasonography of placenta previa at the third trimester of pregnancy: research for signs of placenta accreta/percreta and vasa previa. Prospective color and pulsed Doppler ultrasonography study of 45 cases. J Gynecol Obstet Biol Reprod 28:239–244

    Google Scholar 

  27. Thaler I, Manor D, Itskovitz J, Rottem S, Levit N, Timor-Tritsch I, Brandes JM (1990) Changes in uterine blood flow during human pregnancy. Am J Obstet Gynecol 162:121–125

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan

    Hiroki Ishibashi, Morikazu Miyamoto, Hiroaki Soyama, Masaya Nakatsuka, Takahiro Natsuyama, Masashi Yoshida, Masashi Takano & Kenichi Furuya

  2. Department of Radiology, National Defense Medical College Hospital, Tokorozawa, Saitama, Japan

    Hiroshi Shinnmoto & Wakana Murakami

Authors
  1. Hiroki Ishibashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Morikazu Miyamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Shinnmoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wakana Murakami
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroaki Soyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Masaya Nakatsuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takahiro Natsuyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masashi Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masashi Takano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kenichi Furuya
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Protocol/project development: MM, MT, KF. Data collection or management: MM, HI, MN, TN. Data analysis: HI, HS, WM. Manuscript writing/editing: HI, MM, HS.

Corresponding author

Correspondence to Morikazu Miyamoto.

Ethics declarations

Conflict of interest

We declare that we have no conflict of interest.

Research involving human participants and/or animals

This retrospective study was approved by the Institutional Review Board of the National Defense Medical College, Tokorozawa, Japan.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ishibashi, H., Miyamoto, M., Shinnmoto, H. et al. Cervical varicosities may predict placenta accreta in posterior placenta previa: a magnetic resonance imaging study. Arch Gynecol Obstet 296, 731–736 (2017). https://doi.org/10.1007/s00404-017-4464-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4464-z

Keywords

  • Placenta previa
  • Placenta accreta
  • Magnetic resonance imaging
  • Cervical varicosity