Date post: | 15-Jul-2015 |
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Case Report
Prenatal Ultrasound Diagnosis
Chang Bing Show ChwanMemorial Hospital
Li-hsun Chen
Morbidly
Adherent
Placenta
Miss Chen35Y/o, negative for major systemic disease and past history.Habits of smoking and no alcohol drinking.G3P1A1
2
Case 1
G1: scheduled cesarean section for malpresentation (2012 Oct.) G2: artificial abortion with RU486 (2013 Mar.)G3: LMP 20140510 EDC 20150213Regular antenatal visit our clinic.
10
Four days later, she was transferred to the terminal center for delivery and placed balloon catheterization before cesarean section.
Leave the placenta in situ
Miss Ke39Y/o, negative for major systemic disease and past history.G1P0
11
Case 2
LMP 201405102 EDC 20150214Regular antenatal visit our clinic.
2D sonographic features
19
Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irregular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
2D sonographic features
20
Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irregular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
Loss of retroplacental hypoecoic area
- reflects loss of basal decidua and retroplacental vascular bed
- Se, 50%, PV 55%
2D sonographic features
21
Placental lagoons (vascular lacunae)
- visible from 15 wk
- large, irrrgular shape, multiple
- contain turbulent flow (even without flow)
- Se 79%, PV 92%
Disruption utero-vesical serosa
Extrauterine placental parenchyma
Loss of retroplacental hypoecoic area
- reflects loss of basal decidua and retroplacental vascular bed
- Se, 50%, PV 52%
Progressive thinning of retroplacental myometrium
- If < 1mm
- Se 85%, PV 80%
22
2D color doppler features
Diffuse or focal lacunar flow
Hypervascularity of serosa-bladder interface
Markedly dilated vessels over peripheral subplacental zone
23
2D color doppler features
Diffuse or focal lacunar flow
Hypervascularity of serosa-bladder interface
Markedly dilated vessels over peripheral subplacental zone
Vascular lakes with turbulent flow (PSV > 15 cm/s)
24
Irregular intraplacental vascularization with tortuous confluent vessels crossing placental width.
Hypervascularityof uterine serosa–bladder wall interface.
3D ultrasonography
25
Uterine bulging Heterogenous
signal intensity within placenta
Dark intraplacentalbands on T2 weighted imaging
MRI