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Placenta previa

Case contributed by Manar Alaa El Din osman
Diagnosis almost certain

Presentation

Suspected abnormal placenta location in ultrasound.

Patient Data

Age: 35 years
Gender: Female
mri

Gravid uterus showing low lying placenta reaching the posterior and to lesser extent the anterior walls and completely covering the cervical internal os.

Focal thinning out of the myometrium along the posterior and left lateral walls of the uterus, with loss of the clear retroplacental space yet no evidence of urinary bladder invasion.

No adnexal masses or cysts noted.

Case Discussion

Placenta previa is an obstetric complication in which the placenta is inserted in the lower uterine segment, partially or completely covering the internal os. According to the placenta positon in relation to the cervical internal os, placenta previa is classified into: low lying, marginal, complete and central.

Placenta accreta is a pathological condition in which the placental trophoblast invades the endometrium dut to a defect in the decidua basalis, in severe cases it can invade the myometrium (placenta increta), the serosa or adjacent organs (placenta percreta).

Risk factors for placenta accreta: previous cesarean section, endometrial scarring, previous D&C, placenta previa, smoking and materal age above 35 years.

US: first imaging modality using the grey scale and color doppler with findings include bridging vessels at the placenta-myometrium, myometrium bladder interface, loss of normal retroplacental space, placenta lacunae with turbulent flow.

MRI: adjunctive modality, when US is suspicious or posterior placenta accreta.

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