Role Of Diagnostic Imaging And Surgical Outcomes In Abnormal Placental Invasion Spectrum Associated With Prior Caesarian Delivery Patients: A Prospective Case Series From Western India

ABSTRACT

Background:The aim of our study was to explore the demographics, surgical outcomes and performance of diagnostic imaging modalities namely Ultrasound and Magnetic Resonance Imaging for predicting abnormal placental invasion spectrum in females with history of past caesarian sections.Materials & Methods:We conducted a prospective study from February 2017 till December 2019 at a tertiary referral public hospital in western India. During this time-period we had 26 females satisfying our study criteria. They were subjected to imaging diagnostics to confirm abnormal placental invasiondisorder in their present pregnancy. The imaging findings were compared with the final findings at the time of delivery and pathological examinations of placental specimens.Results:More than two thirds of our study patients were young and belonged to the age group of twenties (mean age 29.5 +/-4.64). Half of them were 3rdgravidas and 77 % (> 3/4 th) of them were diagnosed in their second trimester of pregnancy. Majority of them had history of single past caesarian delivery and the commonest indication for performing it was placenta praevia. Both Ultrasound and MRI were found to be fairly accurate in diagnosing abnormal placental invasion with good sensitivities. Overall, in our series MRI scored an upperhand as a diagnostic imaging modality in posteriorly implanted placentas and cases with ambiguous USG findings.Conclusion:Both diagnostic imaging modalities USG and MRI can predict abnormal placental invasion spectrum with high sensitivity in the antenatal period. These imaging modalities can have a complimentary role, although MRI was found to be superior over USG in our case series with inconclusive findings.