This case report describes two patients who were diagnosed with morbidly adherent placenta during their pregnancies. For the first patient, an ultrasound at 21 weeks showed a low-lying placenta. At 32 weeks, she had massive vaginal bleeding and was diagnosed with placenta previa and morbidly adherent placenta. The second patient was found to have placenta previa without morbid adhesions at 32 weeks. Both patients underwent c-sections, with the first leaving the placenta in situ. The document reviews ultrasound and MRI findings that can help diagnose morbidly adherent placenta, including placental lacunae, loss of the retroplacental hypo

1. Case Report
Prenatal Ultrasound Diagnosis
Chang Bing Show Chwan
Memorial Hospital
Li-hsun Chen
Morbidly
Adherent
Placenta

2. Miss Chen
35Y/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 20150213
Regular antenatal visit our clinic.

3. Sonographic Image at 21st week
3
B
P

4. Sonographic Image at 21st week
4

5. Sonographic Image at 21st week
5
Placenta

6. Sonographic Image at 21st week
6

7. Pregnancy at 32nd week,
she got massive vaginal
bleeding and admitted into
the ward.
7

8. Sonographic Image at 32nd week
8

9. 3D Sonographic Image at 32nd week
9
B
P
Placenta previa with MAP

10. 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

11. Miss Ke
39Y/o, negative for major systemic disease
and past history.
G1P0
11
Case 2
LMP 201405102 EDC 20150214
Regular antenatal visit our clinic.

12. Sonographic Image at 32nd week
12

13. Sonographic Image at 32nd week
13
Placenta previa without MAP

14. 14
Pregnancy at 34th week,
she got massive vaginal bleeding and caserean section .

15. Morbidly Adherent Placenta

16. 16

18. 2D ultrasonography

19. 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%

20. 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%

21. 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. 22
2D color doppler features
 Diffuse or focal lacunar flow
 Hypervascularity of serosa-bladder interface
 Markedly dilated vessels over peripheral subplacental zone

23. 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. 24
Irregular intraplacental vascularization
with tortuous confluent vessels crossing
placental width.
 Hypervascularity
of uterine
serosa–bladder
wall interface.
3D ultrasonography

25. 25
 Uterine bulging
 Heterogenous
signal intensity
within placenta
 Dark intraplacental
bands on T2
weighted imaging
MRI

26. Conclusion
TAS
+ Doppler
TVS
MRI

27. Thanks
for your attentions

28. Chang Bing Show Chwan
Memorial Hospital
Li-hsun Chen
Thanks
for your attentions