Although these parameters are indirect measures of perfusion, they facilitate reproducible and clinically-feasible estimation of tissue perfusion. Quantitative CEUS curves can be characterized by parameters such as time to peak and maximum intensity. CEUS has been used to assess microvascular flow pattern in tumorous lesions in the kidney, and in the cerebrum. Magnetic Resonance Imaging (MRI) has also been proposed as a diagnostic tool for morbidly adherent placenta, but it is a more expensive procedure and inconvenient than ultrasonography.ĬEUS using a microbubble contrast material is a technique that overcomes some of the limitations of Doppler ultrasound. It is sometimes difficult to differentiate placenta retention such as necrotic decidua and blood clots from morbidly adherent placenta by grey-scale and color Doppler ultrasound. However, this modality produces faint signals when blood flows at a low velocity, which may inhibit accurate evaluation of uteroplacental vascularity of morbidly adherent placenta. Color or Power Doppler imaging is another modality that may be used to visualize and evaluate vascular extension from the placental bed. But it is difficult to evaluate placental invasion into the myometrium by grey-scale sonography. Grey scale and color Doppler imaging are commonly used to monitor the treatment effect of morbidly adherent placenta. It is important to evaluate the vascularity of morbidly adherent placenta during the conservative treatment. Uterine artery embolisation may reduce the incidence of massive haemorrhage causing by abnormal and dilated vessels underlying the basal plate. Severe bleeding is the single most significant factor of maternal death worldwide.Īlthough abdominal hysterecyomy is the most definitive management regularly, conservative management not only can preserve the patients’ fertility, but also can reduce morbidity and lower incidence of hysterectomy, blood transfusion, disseminated intravascular coagulation and severe postpartum haemorrhage. Morbidly adherent placenta may cause severe maternal morbidity, including conditions such as uterine perforation, infection, and severe hemorrhage. The incidence of morbidly adherent placenta has risen 13-fold since the early 1900s in parallel with rising Caesarean section rates. It occurs when there is abnormal adherence of the placenta to the uterine wall due to a defect in the decidua basalis. Morbidly adherent placenta is a potentially life-threatening obstetrical emergency. KeywordsĬontrast-enhanced ultrasound, Quantitative analysis, Time-intensity curve, Morbidly adherent placenta, Uteroplacental vascularity, Uterine artery embolisation Introduction CEUS may be a useful tool for the quantitative assessment of uteroplacental vascularity in morbidly adherent placenta after delivery and may be used to follow up the conservative treatment. The 18 cases of nonenhancement expelled the placenta by Dilation and Curettage (D and C) completely 7 days after UAE and the 4 cases of isoenhancement expelled part of the placenta by D and C and hysteroscope were performed 30 days after UAE. The abnormal mass displayed non-enhancement in 18 cases and isoenhancement in 4 cases after UAE. The abnormal mass displayed hyperenhancement before UAE. The PI and the abnormal mass before UAE were higher than that of the normal myometrium (25.8 dB ± 3.2 dB vs. The duration of enhancement before UAE in the abnormal mass was longer than that in the myometrium (262.0 ± 18.3 s vs. The time that the enhancement began before UAE in the abnormal mass was earlier than that in the myometrium (abnormal mass 10.4 ± 1.7 s, myometrium 12.0 ± 2.1 s p=0.007). The images of the CEUS before and after UAE were compared. All the patients undergone UAE combining with Methotrexate (MTX) and were followed up by CEUS. Twenty two cases of morbidly adherent placenta accreta after delivery were examined by gray-scale ultrasound, Color Doppler imaging, and CEUS. The purpose of this study was to explore the clinical value of Contrast-Enhanced Ultrasound (CEUS) using a microbubble contrast agent in evaluating placental vascularity and the effect of Uterine Artery Embolisation (UAE) treatment in morbidly adherent placenta after delivery. Visit for more related articles at Biomedical Research Abstract
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