Abnormal Invasive Placenta: Diagnosis and Management Options

Abnormal invasive placenta is a trophoblastic attachment with the myometrium without the presence of intervening decidua and involves conditions like the placenta accreta, placenta increta and placenta percreta. The primary complication associated with abnormal invasive placenta is a life threatening peripartum hemorrhage, which in turn can lead to disseminated intravascular coagulation, hysterectomy, multiorgan failure, respiratory distress and can also cause death. Accurate diagnosis of such a life threatening medical condition is highly important as it gives rise to significant hemorrhage during the post delivery period, which in turn results in maternal as well as fetal mortality and morbidity. Read on to learn more about the diagnosis and management options for abnormal invasive placenta.

Running head: ABNORMAL INVASIVE PLACENTA
ABNORMAL INVASIVE PLACENTA
Name of the Student
Name of the University
Author Notes

1ABNORMAL INVASIVE PLACENTA
Abnormal invasive placenta is clinically defined as a condition where “a placenta that
cannot be removed spontaneously or manually, without causing severe bleeding” (Rajora and
Singh 2017). It is a trophoblastic attachment with the myometrium without the presence of
intervening decidua and involves conditions like the placenta accreta, placenta increta and
placenta percreta. When the trophoblast remains attached to the myometrium it is called placenta
accreta, when the trophoblast invades the myometrium it is called placenta increta and when the
trophoblast invades beyond the myometrium, serosa, bladder and intestines, it is called placenta
percreta (Fitzpatrick et al. 2014; Thurn et al. 2016). The primary complication associated with
abnormal invasive placenta is a life threatening peripartum hemorrhage, which in turn can lead to
disseminated intravascular coagulation, hysterectomy, multiorgan failure, respiratory distress and
can also cause death. It also increases the risk associated with pre-term birth (Fan et al. 2017).
This is the most common form of placental invasion and occurs in 1 in 7,000 pregnancies.
Depending upon location the maternal mortality rate is up to 7%. The presence of previous
caesarean sections and anterior placenta previa raises the possibility of development of placenta
accreta (Cooper 2012).
Accurate diagnosis of such a life threatening medical condition is highly important as it
gives rise to significant hemorrhage during the post delivery period, which in turn results in
maternal as well as fetal mortality and morbidity (Sparić et al. 2014). One of the techniques used
for the diagnosis of abnormal invasive placenta is the ultrasound technique. It has a sensitivity of
89.5%, has a positive predictive value of 68% and a 98% negative predictive value in the case of
diagnosis of placenta accreta (Berkley and Abuhamad 2013). Ultrasonography helps in the
detection of placenta accreta by identifying features like the loss of retroplacental hypoechoic
zone or its marked thinning, interruptions between the bladder and uterine serosa in the

2ABNORMAL INVASIVE PLACENTA
hyperechoic border, detection of a mass like tissue having echogenicity similar to the
echogenicity of a placenta and also helps in visualizing prominent lakes or vessels within the
myometrium or the placenta. The highest sensitivity in the detection of placenta accreta is the
visualization of lacunae (Shawky, AbouBieh and Masood 2016).
Research has previously been done on the use of ultrasound markers in the detection of
abnormal invasive placenta. Power doppler ultrasound scans have been carried out to determine
the area of confluence or Acon at the uteroplacental interface, which indicated that the area of
confluence was higher in the case of abnormal invasive placenta than a normal placenta (Collins
et al. 2015). However, the studies have revealed the variability of the performance of the markers
for diagnosis of abnormal invasive placenta. However, the limitations of the studies lay in the
small sample size, variability in the inclusion criteria, retrospective design and the diagnosis of
the abnormal invasive placenta. Other limitations include the patient’s body habitus, posterior
location of the placenta and the ultrasound operator skills (Collins et al. 2016).
Based on the background cited, my area of research will be to undertake studies with the
help of the power Doppler ultrasound in order to effectively differentiate between the placenta
accreta, placenta increta and placenta percreta at their early stages, so that timely interventions
can be applied with the aim to reduce maternal and fetal mortality and morbidity. The study
would consider assessment of the abnormal invasive placenta with the help of placental vascular
sonobiopsy (PVS) by 3D power Doppler ultrasound. Sonobiopsy is a valid alternative for
evaluation of the placental vascular tree for convenient visualization of the entire placenta.
VOCAL imaging analysis program would be advantageous in this regard. The study is to
consider at least 50 pregnant women admitted to different healthcare units for delivery recruited
randomly. Pregnancies with an entirely visualized anterior placenta are to be included in the

3ABNORMAL INVASIVE PLACENTA
study (Sato et al., 2016). The research would cover a span of minimum three months for a
thorough analysis. Reports are to be prepared after suitable data analysis with software
application.

4ABNORMAL INVASIVE PLACENTA
Reference List
Berkley, E.M. and Abuhamad, A.Z., 2013. Prenatal Diagnosis of Placenta Accreta. Journal of
ultrasound in medicine, 32(8), pp.1345-1350.
Collins, S.L., Ashcroft, A., Braun, T., Calda, P., Langhoff‐Roos, J., Morel, O., Stefanovic, V.,
Tutschek, B. and Chantraine, F., 2016. Proposal for standardized ultrasound descriptors of
abnormally invasive placenta (AIP). Ultrasound in Obstetrics & Gynecology, 47(3), pp.271-275.
Collins, S.L., Stevenson, G.N., Al-Khan, A., Illsley, N.P., Impey, L., Pappas, L. and Zamudio,
S., 2015. Three-dimensional power Doppler ultrasonography for diagnosing abnormally invasive
placenta and quantifying the risk. Obstetrics & Gynecology, 126(3), pp.645-653.
Cooper, A.C., 2012. The Rate of Placenta Accreta and Previous Exposure to Uterine Surgery.
Fan, D., Li, S., Wu, S., Wang, W., Ye, S., Xia, Q., Liu, L., Feng, J., Wu, S., Guo, X. and Liu, Z.,
2017. Prevalence of abnormally invasive placenta among deliveries in mainland China: A
PRISMA-compliant Systematic Review and Meta-analysis. Medicine, 96(16).
Fitzpatrick, K.E., Sellers, S., Spark, P., Kurinczuk, J.J., Brocklehurst, P. and Knight, M., 2014.
The management and outcomes of placenta accreta, increta, and percreta in the UK: a
population‐based descriptive study. BJOG: An International Journal of Obstetrics &
Gynaecology, 121(1), pp.62-71.
Rajora, P. and Singh, A., 2017. Abnormally invasive placenta: an overview of diagnosis and
management options. International Journal of Reproduction, Contraception, Obstetrics and
Gynecology, 6(11), pp.5013-5017.

5ABNORMAL INVASIVE PLACENTA
Sato, M., Noguchi, J., Mashima, M., Tanaka, H. and Hata, T., 2016. 3D power Doppler
ultrasound assessment of placental perfusion during uterine contraction in labor. Placenta, 45,
pp.32-36.
Shawky, M., AbouBieh, E. and Masood, A., 2016. Gray scale and Doppler ultrasound in
placenta accreta: Optimization of ultrasound signs. The Egyptian Journal of Radiology and
Nuclear Medicine, 47(3), pp.1111-1115.
Sparić, R., Mirković, L., Ravilić, U. and Janjić, T., 2014. Obstetric complications of placenta
previa percreta. Vojnosanitetski pregled, 71(12), pp.1163-1166.
Thurn, L., Lindqvist, P.G., Jakobsson, M., Colmorn, L.B., Klungsoyr, K., Bjarnadóttir, R.I.,
Tapper, A.M., Børdahl, P.E., Gottvall, K., Petersen, K.B. and Krebs, L., 2016. Abnormally
invasive placenta—prevalence, risk factors and antenatal suspicion: results from a large
population‐based pregnancy cohort study in the Nordic countries. BJOG: An International
Journal of Obstetrics & Gynaecology, 123(8), pp.1348-1355.