Abstract
Objectives
To assess the potential of magnetic resonance (MR) imaging in evaluating placental vascularity and predicting placental resorption delay after conservative management of invasive placenta.
Methods
MR examinations of 23 women with conservative management of invasive placenta were reviewed. Twelve women had pelvic embolisation because of postpartum haemorrhage (Group 1) and 11 had no embolisation (Group 2). Comparisons between the two groups were made with respect to the delay for complete placental resorption at follow-up MR imaging and degree of placental vascularity 24 h after delivery on early (30s) and late (180 s) phase of dynamic gadolinium chelate-enhanced MR imaging.
Results
The median delay for complete placental resorption in the cohort study was 21.1 weeks (range, 1-111 weeks). In Group 1, the median delay for complete placental resorption was shorter than in Group 2 (17 vs 32 weeks) (P = 0.036). Decreased placental vascularity on the early phase was observed in Group 1 by comparison with Group 2 (P = 0.003). Significant correlation was found between the degree of vascularity on early phase of dynamic MR imaging and the delay for complete placental resorption (r = 0.693; P < 0.001).
Conclusions
MR imaging provides useful information after conservative management of invasive placenta and may help predict delay for complete placental resorption.
Key Points
• MR imaging is useful after conservative management of invasive placenta.
• MR imaging may help predict delay regarding complete placental resorption.
• Early decreased vascularity correlates with reduced delay of placental resorption.
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References
Khong TY, Robertson WB (1987) Placenta creta and placenta praevia creta. Placenta 8:399–409
Hudon L, Belfort MA, Broome DR (1998) Diagnosis and management of placenta percreta: a review. Obstet Gynecol Surg 53:509–517
Panoskaltsis TA, Ascarelli A, de Souza N, Sims CD, Edmonds KD (2000) Placenta increta: evaluation of radiological investigations and therapeutic options of conservative management. BJOG 107:802–806
O'Brien JM (2007) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 109:203–204
Soyer P, Morel O, Fargeaudou Y, Sirol M, Staub F, Boudiaf M et al (2011) Value of pelvic embolization in the management of severe postpartum hemorrhage due to placenta accreta, increta or percreta. Eur J Radiol 80:729–735
Bretelle F, Courbiere B, Mazouni C, Agostini A, Cravello L, Boubli L et al (2007) Management of placenta accreta: morbidity and outcome. Eur J Obstet Gynecol Reprod Biol 133:34–39
Hayes E, Ayida G, Crocker A (2011) The morbidly adherent placenta: diagnosis and management options. Curr Opin Obstet Gynecol 23:448–453
Pelage JP, Le Dref O, Mateo J, Soyer P, Jacob D, Kardache M et al (1998) Life-threatening primary postpartum hemorrhage: treatment with emergency selective arterial embolization. Radiology 208:359–362
Descargues G, Douvrin F, Degré S, Lemoine JP, Marpeau L, Clavier E (2001) Abnormal placentation and selective embolization of the uterine arteries. Eur J Obstet Gynecol Reprod Biol 99:47–52
Teo SB, Kanagalingam D, Tan HK, Tan LK (2008) Massive postpartum haemorrhage after uterus-conserving surgery in placenta percreta: the danger of the partial placenta percreta. BJOG 115:789–792
La Folie T, Vidal V, Mehanna M, Capelle M, Jaquier A, Moulin G et al (2007) Results of endovascular treatment in cases of abnormal placentation with post-partum hemorrhage. J Obstet Gynaecol Res 33:624–630
Kayem G, Davy C, Goffinet F, Thomas C, Clément D, Cabrol D (2004) Conservative versus extirpative management in cases of placenta accreta. Obstet Gynecol 104:531–536
Oyelese Y, Smulian JC (2006) Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 107:927–941
Kayem G, Pannier E, Goffinet F, Grange G, Cabrol D (2002) Fertility after conservative treatment of placenta accreta. Fertil Steril 78:637–638
Sentilhes L, Ambroselli C, Kayem G, Provansal M, Fernandez H, Perrotin F et al (2010) Maternal outcome after conservative treatment of placenta accreta. Obstet Gynecol 115:526–534
Morel O, Desfeux P, Fargeaudou Y, Malartic C, Rossignol M, Perrotez C et al (2009) Uterine conservation despite severe sepsis in a case of placenta accreta first treated conservatively: 3-month delayed successful removal of the placenta. Fertil Steril 91:1957.e5–1957.e9
Palacios-Jaraquemada JM (2008) Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynaecol 22:1133–1148
Mazouni C, Palacios-Jaraquemada JM, Deter R, Juhan V, Gamerre M, Bretelle F (2009) Differences in the management of suspected cases of placenta accreta in France and Argentina. Int J Gynaecol Obstet 107:1–3
Komulainen MH, Vayrynen MA, Kauko ML, Saarikoski S (1995) Two cases of placenta accreta managed conservatively. Eur J Obstet Gynecol Reprod Biol 62:135–137
Timmermans S, van Hof AC, Duvekot JJ (2007) Conservative management of abnormally invasive placentation. Obstet Gynecol Surv 62:529–539
Noonan JB, Coakley FV, Qayyum A, Yeh BM, Wu L, Chen LM (2003) MR imaging of retained products of conception. AJR Am J Roentgenol 181:435–439
Legro RS, Price FV, Caritis SN (1995) Successful conservative treatment of placenta percreta. Am J Obstet Gynecol 172:1648–1649
Dinkel HP, Dürig P, Schnatterbeck P, Triller J (2003) Percutaneous treatment of placenta perceta using coil embolization. J Endovasc Ther 10:158–162
Greenberg JA, Miner JD, O’Horo SK (2006) Uterine artery embolization and hysteroscopic resection to treat retained placenta accreta: a case report. J Minim invasive Gynecol 13:342–344
Diop AN, Chabrot P, Bertrand A, Constantin JM, Cassagnes L, Storme B et al (2010) Placenta accrete: management with uterine artery embolization in 17 cases. J Vasc Interv Radiol 21:644–648
Alanis M, Hurst BS, Marshburn PB, Matthews ML (2006) Conservative management of placenta increta with selective arterial embolization preserves future fertility and results in a favorable outcome in subsequent pregnancies. Fertil Steril 86:1514.e3–1514.e7
Tanaka YO, Shigemitsu S, Ichikawa Y, Sohda S, Yoshikawa H, Itai Y (2004) Postpartum MR diagnosis of retained placenta accreta. Eur Radiol 14:945–952
Takahama J, Kitano S, Marugami N, Uehara T, Takahashi A, Takewa M et al (2011) Retained placental tissue: role of MRI findings in diagnosis and clinical assessment. Abdom Imaging 36:110–114
El-Bialy G, Kassab A, Armstrong M (2007) Magnetic resonance imagining (MRI) and serial beta-human chorionic gonadotrophin (beta-hCG) follow up for placenta percreta. Arch Gynecol Obstet 276:371–373
Amoh Y, Watanabe Y, Saga T, Dohke M, Sato N, Mitsudo K et al (1995) Retained placenta accreta: MRI and pathologic correlation. J Comput Assist Tomogr 19:827–829
Kanne JP, Lalani TA, Fligner CL (2005) The placenta revisited: radiologic-pathologic correlation. Curr Probl Diagn Radiol 34:238–255
Fargeaudou Y, Morel O, Soyer P, Gayat E, Sirol M, Boudiaf M et al (2010) Persistent postpartum haemorrhage after failed arterial ligation: value of pelvic embolisation. Eur Radiol 20:1777–1785
Fargeaudou Y, Soyer P, Morel O, Sirol M, le Dref O, Boudiaf M et al (2009) Severe primary postpartum hemorrhage due to genital tract laceration after operative vaginal delivery: successful treatment with transcatheter arterial embolization. Eur Radiol 19:2197–2203
Soyer P, Fargeaudou Y, Morel O, Boudiaf M, Le Dref O, Rymer R (2008) Severe postpartum haemorrhage from ruptured pseudoaneurysm: successful treatment with transcatheter arterial embolization. Eur Radiol 18:1181–1187
Gowland P (2005) Placental MRI. Semin Fetal Neonatal Med 10:485–490
Guiot C, Gaglioti P, Oberto M, Piccoli E, Rosato R, Todros T (2008) Is three-dimensional power Doppler ultrasound useful in the assessment of placental perfusion in normal and growth-restricted pregnancies? Ultrasound Obstet Gynecol 31:171–176
Francis ST, Duncan KR, Moore RJ, Baker PN, Johnson IR, Gowland PA (1998) Non-invasive mapping of placental perfusion. Lancet 351:1397–1399
Duncan KR, Gowland P, Francis S, Moore R, Baker PN, Johnson IR (1998) The investigation of placental relaxation and estimation of placental perfusion using echo-planar magnetic resonance imaging. Placenta 19:539–543
Marcos HB, Semelka RC, Worawattanakul S (1997) Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology 205:493–496
Salomon LJ, Siauve N, Balvay D, Cuenod CA, Vayssettes C, Luciani A et al (2005) Placental perfusion MR imaging with contrast agents in a mouse model. Radiology 235:73–80
Chalouhi GE, Deloison B, Siauve N, Aimot S, Balvay D, Cuenod CA et al (2011) Dynamic contrast-enhanced magnetic resonance imaging: definitive imaging of placental function? Semin Fetal Neonatal Med 16:22–28
Neish AS, Frates MC, Tempany CM (1995) Placenta percreta post evacuation: an unusual uterine mass on MRI. J Comput Assist Tomogr 19:824–827
Pelage JP, Soyer P, Repiquet D, Herbreteau D, Le Dref O, Houdart E et al (1999) Secondary postpartum hemorrhage: treatment with selective arterial embolization. Radiology 212:385–389
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Soyer, P., Sirol, M., Fargeaudou, Y. et al. Placental vascularity and resorption delay after conservative management of invasive placenta: MR imaging evaluation. Eur Radiol 23, 262–271 (2013). https://doi.org/10.1007/s00330-012-2573-4
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DOI: https://doi.org/10.1007/s00330-012-2573-4