Comparing three‐dimensional models of placenta accreta spectrum with surgical findings
Open accessAbstract
Objective: Placenta accreta spectrum (PAS) is associated with significant maternal morbidity mainly related to blood loss. Pre‐operative planning is aided by antenatal ultrasound and magnetic resonance imaging. We sought to assess whether three‐dimensional (3D) models from MR images were accurate when compared with surgical and pathological findings. Methods: Digital Imaging and Communications in Medicine files containing MR images with varying severity of PAS (n = 4) were modeled using 3D Slicer. Placenta, bladder, and myometrial defects were modeled. Myometrial defects at three different uterine locations were included—anterior, lateral and inferior. 3D models were used to identify the relationship between the myometrial defect and the internal cervical os. Findings were validated in a larger series of PAS cases (n = 14) where patterns of invasion were compared with estimated blood loss and distance from defect to the internal os. Results: The defect illustrated in the four 3D models correlates to both surgical and pathological findings in terms of depth and pattern of invasion, location of defect, bladder involvement. Blood loss and topography of the defect from 3D modeling were examined in 14 further cases. Inferior defects were associated with increased blood loss compared with anterior defects. Increased distance from cervix was associated with reduced blood loss (R2 = 0.352, P = 0.01). Conclusion: Three‐dimensional models of PAS provide an accurate preoperative description of placental invasion and should be investigated as a tool for selecting patients for uterine‐conserving surgery. Accurate 3D models of placenta accreta spectrum are achievable and may provide additional information, such as distance of the defect from the internal os.
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The authors previously reported a linear relationship between distance from internal cervical os to the most proximal part of the PAS defect on MRI and estimated blood loss, with closer defects associated with significantly higher blood loss.
“Furthermore, we have previously reported a linear relationship between the distance from the internal cervical os to the most proximal part of the PAS defect as seen on MRI and estimated blood loss, with defects closer to the internal os associated with significantly higher blood loss [26].”
From Radiomics-based prediction of FIGO grade for placenta accreta spectrum (2023) · cites this paper as [26]
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Flagged first, then by citations
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Additional file 1 of Radiomics-based prediction of FIGO grade for placenta accreta spectrum
Bartels, H. C., O’Doherty, J., Wolsztynski, E., Brophy, D. P., MacDermott, R., Atallah, D., Saliba, S., Young, C., Downey, P., Donnelly, J. C., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26615047
Self-citation
- Authors
- Mulligan, K. M., Bartels, H. C., Armstrong, F., Immel, E., Corcoran, S., Walsh, J. M., McAuliffe, F., McParland, P., Carroll, S., Higgins, S., Mahony, R., Donnelly, J., Geoghegan, T., Colleran, G., O’Cearbhaill, E., Downey, P., & Brennan, D. J.
- Affiliations
- University College Dublin (IE)
- Rotunda Hospital (IE)
- Mater Misericordiae University Hospital (IE)
- Corresponding author
- Brennan, Donal J.
- ORCID
- Venue
- International Journal of Gynecology & Obstetrics
- Publisher
- Wiley
- Published
- 2021-06-16
- Volume
- 157
- Issue
- 1
- Pages
- 188-197
- ISSN
- 0020-6695 (ISSN-L)
- 0020-7292
- 1879-3479
- OpenAlex
- W3160027448
- Cited by
- 17
- References
- 21
- Citations by year
- 2025: 1 · 2024: 4 · 2023: 8 · 2022: 2 · 2021: 2
- FWCI
- 3.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Gynecology & Obstetrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Physical Sciences › Engineering › Biomedical Engineering › Anatomy and Medical Technology
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- placenta accreta spectrum, 3D modeling, magnetic resonance imaging, myometrial defect, internal cervical os, blood loss, intraoperative findings, pathological features, bladder involvement
- MeSH terms
- Female, Humans, Magnetic Resonance Imaging, Myometrium, Placenta, Placenta Accreta, Placenta Previa, Pregnancy
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