Re: Multiple hypoechoic areas in the placenta
From: udaya kumar (udaya@md2.vsnl.net.in)
Mon Apr 30 23:54:11 2001
Thankyou Terry for enlightening me.
..Udayakumar
DuboseTerryJ@uams.edu wrote:
> Dear Udayakumar, Yes, all you say about "Placenta Accreta would present with
> obliteration of the subplacental hypoechoic/sonolucent space. " is true.
> However, there are reports of obvious abnormal numbers "maternal lakes" and
> placental textural changes in the placenta in the area of Accreta. These
> are not always present, but if abnormal lakes are found in an area near or
> under a prior C Section, then I think Accreta should be considered. See
> number 4 below:
>
> "There have been four distinct sonographic appearances and associations with
> placenta accreta:
> 1) Placenta previa or low lying placenta in association with previous
> Cesarean section(s) or other uterine scaring.
> 2) Loss of the hypoechoic retroplacental zone (vascular bed).
> 3) Thinning or disruption of the hyperechoic uterine serosa-bladder
> interface.
> 4) Presence of unusually numerous intraplacental lakes, venous channels or
> lacunae in the region of the accreta."
>
> See: DuBose, Fetal Sonography, W. B. Saunders 1996, p. 359... also:
>
> . Tabsh KMA, Brinkman CR, and King W; "Ultrasound Diagnosis of Placenta
> Increta"; J Clin Ultrasound, 1982; 10:288-290.
> . Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic Findings in
> Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . ibid 62. Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic
> Findings in Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . Finberg HJ and Williams JW; "Placenta Accreta: Prospective Sonographic
> Diagnosis in Patients with Placenta Previa and Prior Cesarean Section"; J
> Ultrasound Med, 1992; 11:333-343.
> . op cite 61. Tabsh KMA, Brinkman CR, and King W; "Ultrasound Diagnosis
> of Placenta Increta"; J Clin Ultrasound, 1982; 10:288-290.
> . op cite 62. Pasto ME, Kurtz AB, Rifkin MD, et al; "Ultrasonographic
> Findings in Placenta Increta"; J Ultrasound Med, 1983; 2:155-159.
> . Guy GP, Peisner DB, Timor-Tritsch IE; "Ultrasonographic evaluation of
> uteroplacental blood flow patterns of abnormally located and adherent
> placentas"; Am J Obstet Gynecol, 1990; 163:723.
> . op cite 64. Finberg HJ and Williams JW; "Placenta Accreta: Prospective
> Sonographic Diagnosis in Patients with Placenta Previa and Prior Cesarean
> Section"; J Ultrasound Med, 1992; 11:333-343.
> . Hoffman-Tretin JC, Koenigsberg M, Rabin A, et al; "Placenta Accreta:
> Additional Sonographic Observations"; J Ultrasound Med, 1992; 11:29-34.
> . Finberg HJ; "THE PLACENTA AND UMBILICAL CORD: RECENT OBSERVATIONS";
> Lecture and SDMS Official Proceedings: 10th Annual SDMS Conference, Anaheim,
> California, Sept 16-19, 1993; p.243-244.
>
> Peace, Terry J. DuBose, M.S., RDMS, Assistant Professor
> Director, Diagnostic Medical Sonography Program
> CHRP, University of Arkansas for Medical Sciences
> Little Rock, Arkansas, USA
> 501-686-6510
> http://www.io.com/~dubose/
> http://www.uams.edu/CHRP/dmshome.htm
> http://www.obgyn.net/us/panel/panel.htm
>
> -----Original Message-----
> From: udaya kumar [mailto:udaya@md2.vsnl.net.in]
> Sent: Tuesday, April 24, 2001 8:43 PM
> To: Multiple recipients of list ULTRASOUND
> Subject: Re: Multiple hypoechoic areas in the placenta
>
> Dear Terry
> Placenta Accreta would present with obliteration of the subplacental
> hypoechoic/sonolucent
> space. (Maternal venous sinusus get obliterated due to the
> adherence/invasion.)
> I cant see how and why Hypoechoic areas within the placental substance
> should
> help diagnose or coexist with Placenta Accreta .
> I think the case in question is either areas of intervillous thrombi or
> Placental lakes.
> .Udayakumar
>
> DuboseTerryJ@uams.edu wrote:
>
> > With the hypoechoic areas also consider the possibility of Placenta
> Accreta.
> > Particularly in an anterior placenta with a prior C Section or other
> uterine
> > scaring in the anterior area.
> >
> > Terry J. DuBose, M.S., RDMS, Assistant Professor
> > Director, Diagnostic Medical Sonography Program
> > CHRP, University of Arkansas for Medical Sciences
> > Little Rock, Arkansas, USA
> > 501-686-6510
> > http://www.io.com/~dubose/
> > http://www.uams.edu/CHRP/dmshome.htm
> > http://www.obgyn.net/us/panel/panel.htm
> >
> > -----Original Message-----
> > From: Dr Fazeel uz Zaman [mailto:fazeel@atd.hazara.net.pk]
> > Sent: Monday, April 23, 2001 3:22 PM
> > To: Multiple recipients of list ULTRASOUND
> > Subject: Re: Multiple hypoechoic areas in the placenta
> >
> > Usually these are venous lakes and are considered normal........Dr. Fazeel
> >
> > Dr Sarita Bhalerao wrote:
> >
> > > I`d like to know whether multiple hypoechoic areas in a placenta at 13
> > > weeks gestation is suggestive of an aneuploidy and hence warrants
> > > chorion villous biopsy.
