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Re: Developing Accreta From: James S Smeltzer MD (gaperina@mindspring.com) Tue Aug 25 08:48:54 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: James S Smeltzer MD: "Re: Protocols for ER Pelvics" Previous message: Elison R Marshall: "Re: Protocols for ER Pelvics" In reply to: art fougner, md: "Re: Developing Accreta" Next in thread: art fougner, md: "Re: Developing Accreta" Reply: art fougner, md: "Re: Developing Accreta" Art, The last one the MRI also suggested accreta & at section, with much elaborate preparation, a thin LUS had the placenta removed easily. The cystoscopy idea is a good one & over the last fifteen years I have had two with negative cystos, true negatives, so this and the flame-like lakes from base to surface of placenta with generous flow are the best findings in my hands. The MRI may be better able to sort out the layers, but I still do not regard placenta accreta as diagnosable or excludable with a high level of confidence (I have always thought it should be, but it aint). Jim Smeltzer MD gaperina@mindspring.com (:^]> At 07:38 AM 8/24/1998 -0500, you wrote: >Jim, > >look at it this way - the U/S is a screen. if you feel that the images >suggest a high risk for percreta or even increta for that matter, why >not get a targeted MRI? additionally, if bladder involvement is >suspected, then a cysto would shed more light i suspect. fortunately, >these cases are usually few and far between but it does pay to have some >additional diagnostic modalities for the tough cases. btw in our case >posted awhile back, the patient's OB punted to the hospital which quite >predictably took over all aspects of the case. sad to say, i have no >more input and can't even obtain follow-up images. i will post the >outcome, however. > >Art > >At Mon, 24 Aug 1998, James S Smeltzer MD wrote: >> >>At 02:44 PM 8/22/1998 -0500, you wrote: >>> Did not come thru but q was detectability of percreta. >> >>Hi Martin, >> >>In my 15 years of prenatal diagnosis I have been singularly unimpressed >>with my and my peers' ability to perform this simple task. >> >>A patient scanned at a leading sonography center came into our ER DOA >>because of a percreta which was not detected or detectable by a 16 week >>scan done there. I have thought I had percreta on multiple occasions to >>find that I did not. >> >>Others have been through the same thing. >> >>I had an increta which was extensive that was manifested by a second stage >>arrest in a 20 week miscarriage, and by numerous flame-like lakes in the >>placenta (Base to surface & ramified). I did not recognize that as a >>manifestation at the time. This patient died of this cause after delivery. >> I have subsequently seen this four times & three had accreta, two lost >>uterus, two preterm & one normal outcome. >> >>This is humbling, as I approach every problem of pregnancy as diagnosable >>by US until proven otherwise. Why do you ask? Jim Smeltzer MD >>(perinatal@perinatal.net) > >-- >art fougner, md >SonoScan/Genetic Sciences >forest hills, ny >evsono@pipeline.com > Next message: James S Smeltzer MD: "Re: Protocols for ER Pelvics" Previous message: Elison R Marshall: "Re: Protocols for ER Pelvics" In reply to: art fougner, md: "Re: Developing Accreta" Next in thread: art fougner, md: "Re: Developing Accreta" Reply: art fougner, md: "Re: Developing Accreta"

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