Imaging the Uterus in Placenta Accreta Spectrum Disorder.

Area of Science:

• Maternal-fetal medicine
• Diagnostic imaging
• Obstetrics

Background:

• Antenatal diagnosis of placenta accreta spectrum (PAS) is crucial for optimizing maternal and neonatal outcomes.
• Ultrasound is the primary imaging modality for PAS detection.
• Standardized terminology enhances communication among multidisciplinary teams.

Purpose of the Study:

• To outline standardized ultrasound evaluation and reporting for antenatal diagnosis of PAS.
• To highlight early diagnostic markers and comprehensive evaluation methods.
• To emphasize the importance of multidisciplinary planning facilitated by accurate imaging.

Main Methods:

• Utilizing ultrasound, including transabdominal and transvaginal approaches with a partially filled bladder.
• Evaluating gestational sac position and myometrial thickness before 10 weeks.
• Assessing placental lacunae, echostructure, myometrial thinning, hypoechoic zones, and color Doppler flow in later trimesters.

Main Results:

• Early detection is possible via gestational sac location and myometrial thickness (<10 weeks).
• Key markers in later trimesters include placental lacunae, echostructure, myometrial thinning, and abnormal vascularity.
• Standardized reporting includes evaluation optimality, suspicion level (low, moderate, high), and extent (focal, global, beyond uterus).

Conclusions:

• Antenatal ultrasound is essential for evaluating patients at risk for PAS.
• Standardized placental evaluation and reporting improve multidisciplinary team communication.
• While advanced techniques like 3D-power Doppler and MRI are investigational, current ultrasound methods are vital for PAS management.