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Placenta Accreta

An Association With Fibroids and Asherman Syndrome

Department of Maternal-Fetal Medicine, University of Ottawa, Ottawa Hospital, Ottawa, Ontario, Canada (A.A.); Department of Pathology, Kaiser Permanente, San Diego, California USA (A.M.); and Departments of Radiology (M.B., D.P.), Pathology (K.B.), and Reproductive Medicine (A.H.), University of California, San Diego, La Jolla, California USA.

Address correspondence to Dolores H. Pretorius, MD, Department of Radiology, University of California, 9300 Campus Point Dr, 7756, La Jolla, CA 92037 USA. E-mail: dpretorius{at}ucsd.edu

Objective. Placenta accreta is a life-threatening problem that is rising in incidence in the developed world. The increased risk of placenta accreta in women with placenta previa and 1 or more prior cesarean deliveries is well established and prompts careful sonographic evaluation. Our objective was to emphasize that accreta is also identified at sites other than cesarean scars. Methods. Two cases of placenta accreta without placenta previa seen in association with uterine scarring from myomectomy and uterine fibroids are described. Results. The sonographic and magnetic resonance imaging findings of accreta are reviewed in the classic setting of prior cesarean deliveries as well as myomectomy and uterine fibroids. Conclusions. We suggest that when the placenta overlies any uterine abnormality, a careful search for invasive placentation is warranted.

Key Words: accreta • sonography, fibroids • sonography, placenta

Abbreviations: MRI, magnetic resonance imaging