Prenatal Diagnosis and Screening After Mid-Trimester

Dr. Gülşan Karabay1
Dr. Neval Çayönü Kahraman2

1Department of Perinatology, Ankara Etlik City Hospital, Ankara, Türkiye
2Department of Perinatology, Etlik Zübeyde Hanım Training And Research Hospital, Ankara, Türkiye

ABSTRACT

The placenta accreta spectrum (PAS) comprises the conditions known as placenta accreta, increta and per- creta. The PAS is associated with a higher rate of health problems and death in both the mother and the fetus. Timely identification and appropriate therapy are crucial to improve outcomes. Therefore, screening of high-risk patients is recommended. Ultrasonography is the primary imaging modality for detecting PAS and offers excellent sensitivity and specificity in the second and third trimester. Ultrasound reveals multiple pla- cental lacunae, disruption of the bladder lining, absence of the clear zone (loss of retroplacental hypoechoic area), retroplacental myometrial thining, abnormal vascularity, an atypical uterine shape and an exophytic mass. New ultrasound findings such as intraplacental fetal vessels, the jellyfish sign and intracervical lakes are closely associated with maternal morbidity. When these markers are present, the need for a multidisciplinary team increases and referral of patients to a tertiary center becomes necessary. Magnetic resonance imaging (MRI) and three-dimensional power Doppler ultrasound can provide additional diagnostic insights, especially in complicated cases or when ultrasound results are inconclusive. MRI is very valuable for assessing the extent of myometrial and parametrial invasion and bladder involvement. This report emphasizes the importance of a systematic approach to prenatal screening and diagnosis of PAS to ensure optimal maternal and fetal out- comes.

Keywords: Color doppler ultrasonography; Hysterectomy; Placenta accreta spectrum; Prenatal ultrasonographic diagnosis; Postpartum hemorrhage

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