Placenta Accreta

Ultrasound scanning guidelines

Placenta Accreta The possibility of placenta accreta should be considered in all patients with a history of caesarian section. 1st Trimester If the sac is positioned low in the uterus; assess that there is an equal amount of myometrium anterior and posterior to the sac. 2nd and 3rd Trimester When the placenta is anterior and low lying (2nd trimester less than 2cm from the internal os) assess for presence of placental lacunae with grey scale and colour Doppler. If lacunae are present at the morphology scan, a follow-up scan around 24-26 weeks should be planned. Follow-up scan Start with a transabdominal approach with full bladder Confirm that the placenta is low lying Confirm the presence of lacunae Proceed with a transvaginal approach with a half full bladder Re-assessment placental lacunae Check myometrial thickness if possible Check the retroplacental zone Check the bladder uterine serosa interface for evidence of percreta

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