Kalsoom Nawab, Sadaf Naveed, Majid Khan



Placenta Accreta (PA) is the extension of chorionic villi into myometrium due to abnormality in decidua basalis which may lead to massive peripartum haemmorhage, hence putting the life of patient at risk. Therefore, antenatal diagnosis of PA is essential for which ultrasonography (USG) and magnetic resonance imaging (MRI) play a pivotal role. However, USG is an easily accessible and low cost imaging modality as compared to MRI and that is why it is more widely used for screening purposes. 


To determine diagnostic accuracy of USG and MRI in prenatal diagnosis of placenta accreta taking operative findings as gold standard as limited local research has been done on this.


A prospective study was conducted in radiology department of Khyber Teaching Hospital, Peshawar from June, 2014 to June, 2016.  Twenty five antenatal patients who were at high clinical risk of placenta accreta were identified and undergone USG and MRI for confirmation of diagnosis. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated both for USG and MRI.


Twenty five patients at risk of placenta accreta underwent both USG and MRI. Seven cases were diagnosed with placenta accreta per operatively (gold standard). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the USG were 85.7%, 83.3%, 66.7%, 93.8% and 84% respectively. While the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the MRI were 71.4%, 72.2%, 50%, 86.7% and 72% respectively.


The study concluded that diagnostic accuracy of USG is higher than MRI for the antenatal diagnosis of placenta accreta.

Key words:

Magnetic Resonance Imaging; Placenta Accreta; Prenatal Diagnosis; Ultrasonography.

Full Text:



Riteau A-S, Tassin M, Chambon G, Le Vaillant C, de Laveaucoupet J, Que´re Marie-Pierre et al. (2014) Accuracy of Ultrasonography and Magnetic Resonance Imaging in the Diagnosis of Placenta Accreta. PLoS ONE 9(4): e94866. doi:10.1371/journal.pone.0094866.

Bowman ZS, Eller AG, Bardsley TR, Greene T, Varner MW, et Silver RM. Risk Factors for Placenta Accreta: A Large Prospective Cohort. Am J Perinatol. 2014; 31(9):799-804.

Hamisa M, Mashaly E, Fathy S, Tawfeek A. Role of Doppler US and MRI in diagnosis of placenta accreta. Alexandria Journal of Medicine 2015; 51: 225–30.

Christopher Baughman W, Corteville Jane E, Shah Rajiv R. Placenta accreta: Spectrum of US and MR Imaging Findings1. Radiographics. 2008; 28:1905–16.

Shah N, Khan NH. Emergency obstetrical hysterectomy: review of 69 cases. Rawal Med J. 2009; 34:75-8.

Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight Marian. (2012) Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLOS ONE 7: e52893. doi:10.1371/journal.pone.0052893.

Leyendecker JR, DuBose M, Hosseinzadeh K, Stone R, Gianini J, Childs DD et al. MRI of Pregnancy-Related Issues: Abnormal Placentation. Am J Roentgenol. 2012; 198:311-20.

Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005; 192: 1458–61.

Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 2010; 115: 65–9.

Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand. 2011; 90: 1140–46.

Khalid D,Noreen A, Javed A M, Zahra M, Gul M, Shakir A. Diagnostic Accuracy of Color Doppler Ultrasound in Antenatal Diagnosis of Morbidly Adherent Placenta, taking operative findings of cesaerean section as gold standard. Pakistan Journal of Medical and Health Sciences. 2016; 10(2): 478-81.

Shellock FG, Crues JV. MRI procedures: biologic effects, safety and patient care. Radiology 2004; 232:635.

Lam G, Kuller J, McMahon M. Use of magnetic resonance imaging and ultrasound in the antenatal diagnosis of placenta accreta. J Soc Gynecol Invest 2002; 9:37–40.

Oyelese Y, Smulian JC. Placenta previa, placenta accreta and vasa previa. Obstet Gynecol 2006; 107:927–41.

Japaraj RP, Mimin TS, Makudan K. Antenatal diagnosis of placenta previa accreta in patients with previous cesarean scar. J Obstet Gynecol 2007; 33(4):431–7.

Daney de Marcillac F, Moliere S, Pinton A, Weingertner AS, Fritz G, Viville B, et al. Accuracy of placenta accreta prenatal diagnosis by ultrasound and MRI in a high-risk population. Journal of gynecology obstetrics and human reproduction. 2016; 45(2):198-206.

Maher MA, Abdelaziz A, Bazeed MF. Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta. 2013;92(9):1017-22.

Meng X, Xie L, Song W. Comparing the diagnostic value of ultrasound and magnetic resonance imaging for placenta accreta: a systematic review and meta-analysis. Ultrasound Med Biol. 2013; 39:1958–65.

Lerner JP, Deane S, Timor-Tritsch IE. Characterization of placenta accreta using transvaginal sonography and color Doppler imaging. Ultrasound Obstet Gynecol 1995; 5:198–201.

D’Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2013; 42:509–17.

D’Antonio F, Iacovella C, Palacios-Jaraquemada J, Bruno CH, Manzoli L. Prenatal Identification Of Invasive Placentation Using Magnetic Resonance Imaging (MRI): A Systematic Review And Meta-Analysis. Ultrasound Obstet Gynecol. 2014; 44: 8-16.


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