Prediction of Placenta Accreta Spectrum by Prenatal Ultrasound Staging System in Women with Placenta Previa with Scarred Uterus.

Background: Placenta accreta spectrum (PAS) disorders are defined as range of pathological adherence/invasion of placenta. Prenatal diagnosis of PAS disorders using ultrasound doppler can optimize fetomaternal outcome and reduce complications. Objectives: To study the predictive value of prenatal ultrasound staging system for the presence and severity of placenta accreta spectrum and its correlation with fetomaternal outcomes. Method: This was a prospective cohort study conducted in Obstetrics and Gynecology department at VMMC and Safdarjung Hospital, New Delhi, over a period of 18 months. It included 50 women with singleton pregnancy > 28 weeks with placenta previa with scarred uterus after taking informed consent and ethics committee approval. All the women underwent ultrasound and PAS score was assigned, which was correlated with intraoperative FIGO grade, histopathology and fetomaternal outcomes. Results: In 50 women enrolled, prenatal ultrasound staging was performed and PAS score 0, 1, 2 and 3 was assigned. Cesarean hysterectomy was required in all 21(42%) women with PAS score > 0 (PAS 1, 2, 3). Intraoperative, focal and complete invasion was seen in 4% and 38%, respectively, and FIGO grade 1, 2, 3, 4, 5 and 6 was observed in 46%, 16%, 30%, 0%, 6% and 2%, respectively. On histopathology, 14.28% (3/21) with PAS > 0 did not have any invasion, while 85.71% (18/21) had invasion, i.e., accreta, increta and percreta in 57.14%, 19.05% and 9.52%, respectively. Considering histopathology as gold standard, the overall sensitivity, specificity, PPV, NPV and diagnostic accuracy of PAS score were 100%, 90.62%, 85.71%, 100% and 94%, respectively. Conclusion: Prenatal ultrasound staging system is a simple and feasible screening modality. Hence, it should be used in all high-risk women with placenta previa and scarred uterus for definitive prenatal diagnosis of PAS.

Synchronous Oral and Breast Malignancies: A Rare Presentation.

Multiple malignancies may represent metastasis from one location to another or independent primary tumors. The distinction is important because the prognosis and treatment are different. Existence of two malignancies having different histopathologies at anatomically distinct sites is a rare event to occur in an individual. We present one such unusual case of a 40-year-old Indian woman who presented with left breast lump along with a simultaneously occurring growth floor of the mouth. Fine needle aspiration cytology and histopathology revealed features of infiltrating ductal carcinoma breast and adenoid cystic carcinoma of floor of the mouth. This rare organ combination was further managed by surgery and chemo-radiation. To the best of our knowledge, this is the first documentation in the world literature of such a presentation.