Antenatal Diagnosis of Deep Placental Invasion Using Modern Ultrasonographic Techniques: A Case Report
Keywords:
hysterectomy, Placenta Accreta Spectrum (PAS), placenta percreta, ultrasound diagnosis, LumiFlow™, transvaginal ultrasonography, stereoscopic blood flow visualization, magnetic resonance imaging (MRI), maternal complication, cesarean section, cesarean section, maternal complication, Placenta Accreta Spectrum (PAS), placenta percreta, ultrasound diagnosis, LumiFlow™, transvaginal ultrasonography, stereoscopic blood flow visualization, magnetic resonance imaging (MRI),Abstract
Introduction: In recent years, the increasing frequency of cesarean deliveries has contributed to the rising incidence of Placenta Accreta Spectrum (PAS) disorders. This condition represents a serious pregnancy-related complication affecting both maternal and fetal health, associated with the pathological invasion of chorionic villi into the myometrium. The aim of this study is to analyze a clinical case of deep placental invasion and assess the diagnostic utility of ultrasonographic technologies. Case Study: A 35-year-old patient with a history of three cesarean sections underwent routine antenatal screenings at 8, 12, 20, 23, and 28+6 weeks of gestation. Both standard transvaginal and transabdominal ultrasound examinations were performed. Following the diagnosis of placenta increta, magnetic resonance imaging (MRI) was additionally conducted. The diagnosis was confirmed intraoperatively and through histopathological examination. Results: Ultrasound revealed multiple signs of PAS type 2, including significant thinning of the myometrium (<1 mm), placental lacunae, retroplacental hypervascularization, and focal bulging of the placenta in the affected segment. Color Doppler imaging identified abnormal vascular deformation (rail sign), indicating vascular invasion into the myometrium. MRI confirmed the diagnosis of placenta increta (PAS 2). A planned cesarean section was performed, and the diagnosis was confirmed both intraoperatively and histologically. Discussion: This case demonstrates the effectiveness of modern ultrasonographic technologies in differentiating and evaluating deep placental invasion. The findings support a re-evaluation of previous limitations regarding the role of ultrasound in identifying placenta increta. Conclusion: Visualization of blood flow using power Doppler significantly enhances the antenatal diagnosis of deep placental invasion. Innovative ultrasonographic techniques may become an important component of the diagnostic gold standard for PAS disorders.
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