A woman with prior uterine surgery undergoes ultrasound at 20 weeks which shows placenta previa with irregular lacunae within the placenta, loss of the normal hypoechoic retroplacental zone, and Doppler showing turbulent lacunar flow. What is the MOST LIKELY diagnosis?
- A Placenta accreta spectrum (accreta/increta/percreta) ✓
- B Placenta previa alone
- C Velamentous cord insertion
- D Subchorionic hematoma
Correct answer: A. Placenta accreta spectrum (accreta/increta/percreta)
Explanation
The classic ultrasound features of placenta accreta spectrum (PAS) disorder include multiple vascular lacunae (Swiss cheese appearance), loss of the hypoechoic retroplacental myometrial zone, irregular uteroplacental interface, and turbulent lacunar Doppler flow. PAS occurs in women with prior uterine surgery (especially cesarean) combined with anterior low-lying or previa placenta. MRI is used for further characterization. Anticipatory planning for delivery at a tertiary center with potential hysterectomy is essential.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.