Accuracy of ultrasound in antenatal diagnosis of placental attachment disorders.

OBJECTIVES: To evaluate the accuracy of ultrasound in the diagnosis of placenta accreta and its variants, and to assess the impact of prenatal diagnosis in our population. METHODS: A total of 314 women with placenta previa were enrolled prospectively and underwent transabdominal and transvaginal ultrasound examinations. An ultrasound diagnosis (grayscale and color/power Doppler) of placental attachment disorder (PAD) was based on the detection of at least two of the following ('two-criteria system'): loss/irregularity of the retroplacental clear zone, thinning/interruption of the uterine serosa-bladder wall interface, turbulent placental lacunae with high velocity flow, myometrial thickness < 1 mm, increased vascularity of the uterine serosa-bladder wall interface, loss of vascular arch parallel to the basal plate and/or irregular intraplacental vascularization. Definitive diagnosis was made at delivery by Cesarean section. Maternal outcome in cases diagnosed antenatally was compared with that in cases diagnosed at delivery. RESULTS: There were 37/314 cases of PAD (29 anterior and eight posterior). The two-criteria system identified 30 cases of placenta accreta, providing a sensitivity of 81.1% and specificity of 98.9%. When anterior and posterior placentae were considered separately, the detection rates of PAD were 89.7 and 50.0%, respectIvely. Maternal outcome was better in women with prenatal diagnosis of PAD, as seen by less blood loss and shorter hospitalization. CONCLUSIONS: Our data confirmed that grayscale and color Doppler ultrasound have good performance in the diagnosis of PAD and that prenatal diagnosis improves maternal outcome. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Management of patients with intrauterine fetal death.

Fetal death incidence is 5-10 per 1,000 births. About 25% of the women who carry a dead fetus for more than 4 weeks will show significant alterations in their coagulation system. The treatment for a patient with endouterine fetal death depends on when the pregnancy is terminated, based on the ecographic fetus age. There were 15,070 births from January 1983 to December 1994 in Department B of the Institute of Obstetrics and Gynecology, University of Torino. We took into consideration the cases ofintrauterine fetal death between the 26th and 40th week before labour. This study is based on a cohort of 57 cases of intrauterine fetal demise from the 24th to the 40th week of pregnancy before spontaneous labour.

[Laminaria in induction of abortion in the 2d trimester. Case of uterine rupture]. / La laminaria nell'induzione d'aborto al 2no trimestre. Caso di rottura d'utero.

PIP: A 32 year old patient in her 25th week of gestation was hospitalized for endouterine fetal death. The sample patient in previous years had 2 cesarean sections, both times for early detachment of the placenta with consequent fetal death. Cervical dilatation was induced with a Hagar dilator and with laminaria tents, sudden spontaneous and strong contractions led to echography which showed uterine rupture. Laparotomy and hysterectomy were then performed. The use of laminaria followed by surgical evacuation is considered almost free of side effects in the first half of 2nd trimester pregnancy, while prostaglandins are preferred in the 2nd half. According to recent studies laminaria can provoke strong contractions in about 30% of cases and especially if the patient is nulliparous. This last risk factor negatively influenced the outcome of uterine evacuation in the case presented here since the uterine wall had already been weakened by 2 preceding cesarean sections.^ieng