Diagnostic value of ultrasonography and magnetic resonance imaging in pregnant women at risk for placenta accreta.

OBJECTIVE: The purpose of this study was to evaluate whether ultrasonography and magnetic resonance imaging can detect placenta accreta reliably in at-risk patients. PATIENTS AND METHODS: Thirty-nine gravid women with abnormal placentation and previous uterine surgery were collected after meeting the inclusion criteria depending on gray scale sonographic findings which suggested placenta accreta. Ultrasonography (US) and resonance imaging (MRI) findings were classified as positive and negative according to presence or absence of imaging criteria of placenta accreta. RESULTS: The surgical findings of our patients confirmed placenta accreta in 8/39 (20.5%) patients. According to gray scale and color Doppler US 11/39 (28.2%) patients were positive and 28/39 (71.8%) were negative for placenta accreta. According to MRI findings, 12/39 (30.7%) patients were positive for placenta accreta and 27/39 (69.3%) were negative. Sensitivity, specificity, positive predictive value, negative predictive value of US and MRI were 82.0%, 89.6%, 72.7%, 92.8% and 88.8%, 86.8%, 66.6%, 96.2%, respectively. CONCLUSION: US and MRI were useful in the diagnosis of placenta accreta with lacunae and an abnormal color Doppler imaging pattern are the most helpful findings. MRI is most clearly indicated when US findings are ambiguous or there is a posterior placenta.

Maternal serum endoglin as an early marker of pre-eclampsia in high-risk patients.

BACKGROUND: Pre-eclampsia is a potentially serious condition that still accounts for significant morbidity and mortality for the affected mother and neonate. Although the pathogenesis is not fully understood, it is now widely accepted that vascular endothelial dysfunction is the most important and principal event in the pathophysiology of the disease. The aims of our study were to compare serum soluble endoglin levels at week 13 in normotensive pregnant women and in high-risk women, to determine whether the maternal plasma soluble endoglin concentration at 26 weeks is increased in pregnancies that subsequently develop pre-eclampsia, and to identify if soluble endoglin measurement improves the results of screening for pre-eclampsia. METHODS: This work was conducted in 60 healthy pregnant controls and 110 pregnant women at high risk for pre-eclampsia. Gestational age was confirmed by date of last menstrual period and first trimester ultrasound. The time of onset of pre-eclampsia was defined as the time of first elevated blood pressure or urinary protein measurement leading to the diagnosis. Blood samples were collected for measurement of soluble endoglin and other routine laboratory tests, including measurement of urinary proteins. Serum soluble endoglin was estimated by sandwich enzyme-linked immunosorbent assay. RESULTS: There was a highly significant increase in serum soluble endoglin in high-risk women compared with controls at week 13 (P < 0.001). Further determination of soluble endoglin revealed a more significant increase in women who developed early-onset pre-eclampsia compared with those who developed late-onset pre-eclampsia. Moreover, a significant positive correlation was found between soluble endoglin and both diastolic blood pressure and total urinary protein, ie, severity of pre-eclampsia. CONCLUSION: Estimation of serum soluble endoglin at gestational week 13 could be used as a sensitive screening test for women at high risk of developing pre-eclampsia prior to onset of its clinical manifestations, which could potentially improve the outcome of pregnancy.