OBGY Radiology


Case 7 :

A 30-year-old female presents with bleeding PV since 7 days, immediately after delivery of a male child in her village. USG is asked for. 
What is the diagnosis?

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Imaging Findings
Study shows an involuting uterus with presence of an echogenic lesion (retained placenta) in the endometrial cavity. Loss of interface between the retained placenta and myometrium was noted. Invasion of myometrium was noted posteriorly. Vascularity was demonstrated within this lesion.

Diagnosis
Placenta increta

Discussion
Placenta accreta has been defined as a placenta with abnormal adherence, either in whole or part to the uterine wall. This abnormality is characterized by myometrial invasion by the villi and occurs when the deciduas basalis is partially or completely absent. This entitiy is classified according to the degree of myometrial invasion: placenta accreta vera is when the villi are simply attached to the myomterium, placenta increta is when the villi penetrate deep into the myometrium, and placenta percreta, when the villi penetrate the entire thickness of the uterine wall.

All conditions or procedures that affect the integrity of the uterine wall, such as cesarean section, fibroids, curettage are peredisposing factors for abnormal villous penetration. In amy patients, the association of a prior uterine scar and low placental insertion is a significant risk.

Prenatal diagnosis of this condition can allow the obstetrician to demarcate the areas of placenta that may require resection prior to undertaking surgery.

References
Ultrasound in Obstetrics & Gynecology. Authors: Meire-Cosgrove-Dewbury-Wilde. Chp. Placenta and cord. Churchill Livingstone 1993. pgs: 442-443.

Contribution
Dr. Sanjeev Mani, Mumbai, India