Vol 94, No 3 (2023)
Research paper
Published online: 2023-02-20

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The potential role of preoperative cystoscopy for determining the depth of invasion in the placenta accreta spectrum

Furkan Çetin12, Seyhun Sucu2, Hüseyin Çağlayan Özcan2, Özge Kömürcü Karuserci2, Çağdaş Demiroğlu3, Muhammed Hanifi Bademkiran2, Emin Sevinçler2
Pubmed: 36929798
Ginekol Pol 2023;94(3):242-248.


Objectives: This study aims to determine the role of preoperative cystoscopy in specifying the degree of placental invasion to the bladder in the placenta accreta spectrum (PAS), especially in percreta. Material and methods: This prospective observational cohort study included 78 PAS patients. All included patients underwent the preoperative cystoscopy before the cesarean hysterectomy operation. The preoperative cystoscopy procedure identified markers of PAS as neovascularization, arterial pulsatility in neovascularized zones, and posterior bladder wall bulging. Then the patients were divided into subgroups according to the histopathological results of their cesarean hysterectomy specimens. Finally, the histopathological subgroups of PAS were estimated using preoperative cystoscopy signs in the designed logistic regression analysis model. Results: The preoperative cystoscopic signs such as neovascularization, the posterior bladder wall bulging, and the arterial pulsatility in neovascularized zones were approximately associated with a 17-fold [OR = 16.9 (95% CI, 5.7–49.8)], 26-fold [OR = 26.1 (95% CI, 8.17–83.8)], and 9-fold [OR = 8.94 (95% CI, 2.94–27.1)] increase in the likelihood of placenta percreta, respectively. Conclusions: Preoperative cystoscopy may significantly contributions to other standard imaging modalities to identify the degree of placental invasion, especially placenta percreta. Experienced obstetricians trained in hysteroscopic visualization may safely perform this preoperative cystoscopy procedure under the guidance of a specialist urologist. Accordingly, it may be possible to estimate the degree of invasion and the course of surgery in patients with PAS using the preoperative cystoscopy procedure.

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  1. Lasica M, Sparrow RL, Tacey M, et al. members of the Australian and New Zealand Massive Transfusion Registry Steering Committee. Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry. Br J Haematol. 2020; 190(4): 618–628.
  2. Cahill AG, Beigi R, Heine RP, et al. Society of Gynecologic Oncology, American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Placenta Accreta Spectrum. Am J Obstet Gynecol. 2018; 219(6): B2–BB16.
  3. Silver RM, Branch DW. Placenta Accreta Spectrum. N Engl J Med. 2018; 378(16): 1529–1536.
  4. Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol. 2018; 218(1): 75–87.
  5. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005; 192(5): 1458–1461.
  6. Berkley EM, Abuhamad A. Imaging of Placenta Accreta Spectrum. Clin Obstet Gynecol. 2018; 61(4): 755–765.
  7. Algebally AM, Yousef RR, Badr SS, et al. The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation. Pol J Radiol. 2014; 79: 409–416.
  8. Jauniaux E, Chantraine F, Silver RM, et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Epidemiology. Int J Gynaecol Obstet. 2018; 140(3): 265–273.
  9. Tam Tam KB, Dozier J, Martin JN. Approaches to reduce urinary tract injury during management of placenta accreta, increta, and percreta: a systematic review. J Matern Fetal Neonatal Med. 2012; 25(4): 329–334.
  10. Buca D, Liberati M, Calì G, et al. Influence of prenatal diagnosis of abnormally invasive placenta on maternal outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018; 52(3): 304–309.
  11. Jauniaux E, Bhide A, Kennedy A, et al. FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet. 2018; 140(3): 274–280.
  12. Liu Y, Fan D, Fu Y, et al. Diagnostic accuracy of cystoscopy and ultrasonography in the prenatal diagnosis of abnormally invasive placenta. Medicine (Baltimore). 2018; 97(15): e0438.
  13. Al-Khan A, Guirguis G, Zamudio S, et al. Preoperative cystoscopy could determine the severity of placenta accreta spectrum disorders: An observational study. J Obstet Gynaecol Res. 2019; 45(1): 126–132.
  14. Cnota W, Banas E, Dziechcinska-Poletek D, et al. "The Killer Placenta" - a threat to the lives of young women giving birth by cesarean section. Ginekol Pol. 2022 [Epub ahead of print].
  15. Sucu S, Özcan HÇ, Karuserci ÖK, et al. Is there a role of prophylactic bilateral internal iliac artery ligation on reducing the bleeding during cesarean hysterectomy in patients with placenta percreta? A retrospective cohort study. Ginekol Pol. 2021; 92(2): 137–142.
  16. Pyra K, Szmygin M, Dymara-Konopka W, et al. Maternal and perinatal outcomes in placenta accreta spectrum disorders with prophylactic internal iliac artery balloon catheterization and embolization. Ginekol Pol. 2022; 93(12): 980–986.
  17. Gulucu S, Uzun KE. Evaluation of blood transfusion rate in obstetric patients. Ginekol Pol. 2022; 93(8): 637–642.
  18. Eller AG, Porter TF, Soisson P, et al. Optimal management strategies for placenta accreta. BJOG. 2009; 116(5): 648–654.
  19. Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am. 2015; 42(2): 381–402.
  20. Belfort MA. Publications Committee, Society for Maternal-Fetal Medicine. Placenta accreta. Am J Obstet Gynecol. 2010; 203(5): 430–439.
  21. Konijeti R, Rajfer J, Askari A. Placenta percreta and the urologist. Rev Urol. 2009; 11(3): 173–176.
  22. Tikkanen M, Paavonen J, Loukovaara M, et al. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand. 2011; 90(10): 1140–1146.
  23. Rezk MAA, Shawky M. Grey-scale and colour Doppler ultrasound versus magnetic resonance imaging for the prenatal diagnosis of placenta accreta. J Matern Fetal Neonatal Med. 2016; 29(2): 218–223.
  24. Baughman WC, Corteville JE, Shah RR. Placenta accreta: spectrum of US and MR imaging findings. Radiographics. 2008; 28(7): 1905–1916.
  25. Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. 2006; 108(3 Pt 1): 573–581.
  26. Familiari A, Liberati M, Lim P, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018; 97(5): 507–520.
  27. Thurn L, Lindqvist PG, Jakobsson M, et al. Abnormally invasive placenta-prevalence, risk factors and antenatal suspicion: results from a large population-based pregnancy cohort study in the Nordic countries. BJOG. 2016; 123(8): 1348–1355.
  28. Fitzpatrick KE, Sellers S, Spark P, et al. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014; 121(1): 62–70; discussion 70.
  29. Bailit JL, Grobman WA, Rice MM, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Morbidly adherent placenta treatments and outcomes. Obstet Gynecol. 2015; 125(3): 683–689.
  30. Fan D, Wu S, Wang W, et al. Prevalence of placenta previa among deliveries in Mainland China: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore). 2016; 95(40): e5107.
  31. Norris BL, Everaerts W, Posma E, et al. The urologist's role in multidisciplinary management of placenta percreta. BJU Int. 2016; 117(6): 961–965.