Donald School Journal of Ultrasound in Obstetrics and Gynecology

Register      Login

VOLUME 12 , ISSUE 3 ( July-September, 2018 ) > List of Articles


Placenta–From Basic Facts to Highly Sophisticated Placenta Accreta Story

Gabriella Minneci, Giuseppe Cali

Keywords : Early diagnosis of pathological entities, Placenta, Placental diseases

Citation Information : Minneci G, Cali G. Placenta–From Basic Facts to Highly Sophisticated Placenta Accreta Story. Donald School J Ultrasound Obstet Gynecol 2018; 12 (3):168-185.

DOI: 10.5005/jp-journals-10009-1569

License: CC BY-NC 4.0

Published Online: 01-12-2009

Copyright Statement:  Copyright © 2018; The Author(s).


The study of the placenta is a fundamental aspect of pregnancy management from the first to the third trimester. In the last years, the increased ultrasound technology has given us new possibilities of diagnosis, often with great importance in the clinical practice. This paper discusses the most know placental diseases but highlights the importance of some emerging pathological entities, whose early diagnosis or suspect may significantly improve maternofetal outcomes.

PDF Share
  1. Kliman HJ. Trophoblast infiltration. Reproductive Medicine Review. 1994;3:137-157.
  2. Kliman HJ. The placenta revealed. Am J Pathol. 1993;143(2):332-336.
  3. Sebire NJ, Sepulveda W. Correlation of placental pathology with prenatal ultrasound findings. Clin Pathol. 2008;61(12):1276-1284.
  4. Fox H. The development and structure of the placenta. In: Fox H (Ed.). Pathology of the placenta. Philadelphia: WB Saunders; 1997. pp. 1-16.
  5. Abramowicz JS, Sheiner E. Ultrasound of the placenta: a systematic approach. Part I: Imaging. Placenta. 2008;29(3):225-240.
  6. Harris RD, Alexander RD. Ultrasound of the placenta and umbilical cord. In: Callen PW (Ed). Ultrasonography in Obstetrics and Gynecology, 4th edition. Philadelphia: WB Saunders Co; 2000. pp. 597-625.
  7. Grannum PA, Berkowitz RL, Hobbins JC. The ultrasonic changes in the maturing placenta and their relation to fetal pulmonic maturity. Am J Obstet Gynecol. 1979;133(8):915- 22.
  8. Angtuaco TL, Boyd CM, Marks SR, Quirk JG, Galwas B Sonographic diagnosis of the bilobate placenta. J Ultrasound Med 1986;5:672-674.
  9. Finberg HJ. Umbilical cord and amniotic membranes. In: McGahan JP, Goldberg BB (Eds). Diagnostic ultrasound-A logical approach, 1st edition. Philadelphia: Lippincott- Raven Publishers; 1998.pp.201-229.
  10. Predanic M, Perni SC, Baergen RN, et al. A sonographic assessment of different patterns of placenta previa “migration” in the third trimester of pregnancy. J Ultrasound Med. 2005;24(6):773-780.
  11. Ekoukou D, Ng Wing Tin L, Nere MB, et al. Placenta membranacea. Review of the literature, a case report. J Gynecol Obstet Biol Reprod (Paris) 1995;24:189-193.
  12. Greenberg JA, Sorem KA, Shifren JL, et al. Placenta membranacea with placenta increta: a case report and literature review. Obstet Gynecol 1991;78 (3 Pt 2):512-514.
  13. McCarthy J, Thurmond AS, Jones MK, et al. Circumvallate placenta: sonographic diagnosis. J Ultrasound Med. 1995;14(1):21-26.
  14. Harris RD, Wells WA, Black WC, et al. Accuracy of prenatal sonography for detecting circumvallate placenta. AJR Am J Roentgenol. 1997;168(6):1603-1608.
  15. Tikkanen M. Placental abrupton: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 2011 Feb;90 (2):140-149.
  16. Tikkanen M. Etiology, clinical manifestations, and prediction of placental abruption. Acta Obstet Gynecol Scand 2010;89: 732-740.
  17. Nyberg DA, Mc Gahan JP, Pretorius DH, Pilu G. The placenta Umbilical Cord and Membranes - Placental Hemorrhage/Abruption. In: “Diagnostic Imaging of fetal Anomalies”. Lippincot Williams and Wilkins 2003;99-102.
  18. Nyberg DA, Cyr DR, Mack LA, Wilson DA, Shuman WP. Sonographic spectrum of placental abruption. AJR Am J Roentgenol 1987 Jan; 148 (1):161-164.
  19. FIGO Oncology Committee et al. FIGO staging for gestational trophoblastic neoplasia 2000. FIGO Oncology Committee. Int J Gynecol Obstet 2002;77:285.
  20. Palmer JE, Macdonald M, Wells M, Hancock BW, Tidy JA. Epithelioid trophoblastic tumor: a review of the literature. J Reprod Med 2008;53:465-475.
  21. Nguyen D, Nguyen C, Yacobozzi M, Bsat F, Rakita D. Imaging of the placenta with pathologic correlation. Semin Ultrasound Ct MRI 2012;33:65-77.
  22. Guschmann M, Henrich W, Dudenhausen JW. Chorioangiomas-new insights into a well-known problem. II. An immunohistochemical investigation of 136 cases. J Perinat Med 2003;31:170.e5.
  23. Abramowicz JS, Sheiner E. In utero imaging of the placenta: importance for diseases of pregnancy. Placenta 2007;28: S14-22.
  24. Calì G, Giambanco L, Puccio G, et al. Morbidly adherent placenta: an evaluation of ultrasound diagnostic criteria and an attempt to differentiate placenta accreta from percreta. Ultrasound Obstet Gynecol 2013;41:406-412.
  25. Wolfe BK, Wallace JHK. Pitfall to avoid: chorioangioma of the placenta simulating fetal tumor. J Clin Ultrasound 1987; 15:405-408.
  26. Reinhart RD, Wells WA, Harris RD. Focal aneurysmal dilatation of subchorionic vessels simulating chorioangioma. Ultrasound Obstet Gynecol 1999;13:147-149.
  27. Braun T, Brauer M, Fuchs I, et al. Mirror syndrome: a systematic review of fetal associated conditions, maternal presentation and perinatal outcome. Fetal Diagn Ther 2010; 27:191-203.
  28. Moscoso G, Jauniaux E, Hustin J. Placental vascular anomaly with diffuse mesenchymal stem villous hyperplasia. A new clinico-pathological entity? Pathol Res Pract 1991;187: 324-328.
  29. Arizawa M, Nakayama M. Suspected involvement of the X chromosome in placental mesenchymal dysplasia. Congenital Anomalies 2002;42(4):309-317.
  30. Nayeri UA, West AB, Grossetta Nardini HK, et al. Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome. Ultrasound Obstet Gynecol 2013;41:366–374.
  31. Robertson M, Geerts LT, de Jong G, et al. Mesenchymal dysplasia in a monochorionic diamniotic twin pregnancy with review of the differential diagnosis of cystic changes in the placenta. J Ultrasound Med. 2007;26:689-693.
  32. Gizzo S, Gangi SD, Patrelli TS, et al. Placental mesenchymal dysplasia: can early diagnosis ensure a good materno-fetal outcome? A case report. Arch Gynecol Obstet. 2012;286: 15-17.
  33. Parveen Z, Tongson-Ignacio JE, Fraser CR, Killeen JL, Thompson KS. Placental mesenchymal dysplasia. Arch Pathol Lab Med. 2007;131:131-137.
  34. Umazume T, Kataoka S, Kamamuta K, et al. Placental mesenchymal dysplasia: a case of intrauterine sudden death of fetus with rupture of cirsoid periumbilical chorionic vessels. Diagnostic Pathology. 2011;38:1-7.
  35. Gibson BR, Padilla JM, Champeaux A, et al. Mesenchymal dysplasia of the placenta. Placenta. 2004;25:671-672.
  36. Pham T, Steele J, Stayboldt C, et al. Placental mesenchymal dysplasia is associated with high rates of intrauterine growth restriction and fetal demise. Am J Clin Pathol. 2006; 126:67-78.
  37. Paradinas FJ, Sebire NJ, Fisher RA, Rees HC, Foskett M, Seckl MJ, et al. Pseudo-partial moles: placental stem vessel hydrops and the association with Beckwith-Wiedemann syndrome and complete moles. Histopathology. 2001;39: 447-454.
  38. Heazell AEP, Sahasrabudhe N, Grossmith AK, Martindale EA, Bhatia K. A case of intrauterine growth restriction in association with placental mesenchymal dysplasia with abnormal placental lymphatic development. Placenta. 2009; 30:654-657.
  39. Committee on Obstetric Practice ACOG Committee opinion. Placenta accrete. No 266, January 2002. Int J Obstet Gynecol. 2002;77(1):77-78.
  40. Izabela UW, Krzysztof N, Ryszard P, et al. Placenta praevia increta with caesarean section scar invasion. Ginekol Pol. 2011;82(6):471-473.
  41. Miller DA, Chollet JA, Goodwin TM.: Clinical risk factors for placenta previa-placenta accrete. Am. J. Obstet Gynecol. 1997;177:210-214.
  42. Esakoff TF, Sparks TN, Kaimal AJ, et al. Diagnosis and morbidity of placenta accreta. Ultrasound Obstet Gynecol. 2011 Mar;37(3):324-327.
  43. Gielchinsky Y, Rojansky N, Fasouliotis SJ, et al. Placenta accreta--summary of 10 years: a survey of 310 cases. Placenta. 2002 Feb-Mar;23(2-3):210-214.
  44. Clark SL, Koonings PP, Phelan JP: Placenta previa/accrete and prior caesarean section. Obstet Gynecol. 1985;66:89.
  45. Spong CY, Berghella V, Wenstrom KD, Mercer BM, Saade GR. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol 2012;120:1181-1193.
  46. Cesarean Rates. World Caesarean Rates: OECD Countries (Arnold J). [online] Available from https://www.cesareanrates. org/unnecesareanblogarchive/2012/12/8/ World-Caesarean-Rates-OECD-Countries.
  47. Calì G, Giambanco L. Abnormal placental adherence: An obstetrical arising complication. A proposal of early diagnostic work-up. Italian Journal of Gynaecology and Obstetrics 01/2011;23(1):9-18.
  48. Leerentveld RA, Gilberts ECAM, Arnold KJCW, et al. Accuracy and safety of transvaginal sonographic placental localization. Obstet Gynecol 1990;76:759-62.
  49. Cho JY, Lee YH, Moon MH, Lee JH. Difference in migration of placenta according to the location and type of placenta previa. J Clin Ultrasound. 2008 Feb;36(2):79-84.
  50. Morrison J. The development of the lower uterine segment. Aust NZ J Obstet Gynaecol 1982;12:182-185.
  51. Benirschke K, Kaufmann P. The pathology of the human placenta. New York: Springer-Verlag, 1990:202-204.
  52. Lauria MR, Smith RS, Treadwell MC, et al. The use of second- trimester transvaginal sonography to predict placenta previa. Ultrasound Obstet Gynecol 1996;8:337-340.
  53. Oppenheimer l, Holmes P, Simpson, Simpson N, et al. Diagnosis of low-Lying placenta: can migration in the third trimester predicr outcome? Ultrasound Obstet Gynecol 2001;18:100-102.
  54. Calì G. Prevention of postpartum hemorrhage and hysterectomy in patients with morbidly adherent placenta: A cohort study comparing outcomes before and after introduction of the Triple-P procedure. V. Teixidor VIñas, A. M. Belli, S. Arulkumaran and E. Chandraharan. Ultrasound Obstet Gynecol 2015;46:350-355. Ultrasound in Obstetrics and Gynecology 09/2015;46(3).
  55. D'Antonio F, Palacios-Jaraquemada JM, Lim PS, et al. Counseling in fetal medicine: evidence based answer to clinical questions on morbidly adherent placenta. Ultrasound in Obstetrics and Gynecology 07/2015.
  56. Lerner JP, Deane S, Timor-Tritsch IE. Characterization of placenta accreta using transvaginal sonography and color Doppler imaging. Ultrasound Obstet Gynecol. 1995 Mar;5(3):198-201.
  57. Chou MM, Ho ES, Lee YH. Prenatal diagnosis of placenta previa accreta by transabdominal color Doppler ultrasound. Ultrasound Obstet Gynecol. 2000 Jan;15(1):28-35.
  58. Comstock CH, Love JJ Jr, Bronsteen RA, et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol. 2004 Apr;190(4):1135-1140.
  59. Comstock CH. Antenatal diagnosis of placenta accreta: a review. Ultrasound Obstet Gynecol. 2005 Jul;26(1):89- 96.
  60. Callan PW, Filly RA. The placental-subplacental complex: a specific indicator of placental position on ultrasound. J Clin Ultrasound 1980;8:21-26.
  61. McGahan JP, Phillips HE, Reid MH. The anechoic retroplacental area: a pitfall in diagnosis of placentalendometrial abnormalities during pregnancy. Radiology 1980;134:475-478.
  62. Pasto ME, Kurtz AB, Rifkin MD, Cole-Beuglet C, Wapner RJ, Goldberg BB. Ultrasonographic findings in placenta increta. J Ultrasound Med 1983;2:155-159.
  63. Finberg HJ, Williams JW. Placenta accreta: prospective sonographic diagnosis in patients with placenta previa and prior cesarean section. J Ultrasound Med 1992;11:333-343.
  64. Wong HS, Cheung YK, Zuccollo J, et al. Evaluation of sonographic diagnostic criteria for placenta accreta. J Clin Ultrasound. 2008 Nov-Dec;36(9):551-559.
  65. Shih JC, Palacios Jaraquemada JM, Su YN, et al. Role of three-dimensional power Doppler in the antenatal diagnosis of placenta accreta: comparison with gray-scale and color Doppler techniques. Ultrasound Obstet Gynecol. 2009 Feb;33(2):193-203.
  66. D'Antonio F, Iacovella C, Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2013;42: 509-517.
  67. Christine H. Comstock The antenatal diagnosis of placental attachment disorders. Current Opinion in Obstetrics and Gynecology 2011;23:117-122.
  68. Chou MM, Chen W, Tseng J, et al. Prenatal detection of bladder wall involvement in invasive placentation with sequential two-dimensional and adjunctive threedimensional ultrasonography. Taiwan J Obstet Gynecol. 2009;48:1.
  69. Levine D, Hulka CA, Ludmir J, et al.. Placenta accreta: evaluation with color Doppler US, Power Doppler US, and MR imaging. Radiology 1997;205:773-776.
  70. Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. RCOG Green-top Guideline No. 27 January 2011.
  71. Cali G, Forlani F. Three-dimensional sonographic virtual cystoscopy in a case of placenta percreta. Ultrasound in Obstetrics and Gynecology. 2014;43(4):481-482.
  72. Palacios-Jaraquemada JM. Diagnosis and management of placenta accreta. Best Pract Res Clin Obstet Gynaecol. 2008 Dec;22(6):1133-48. Epub 2008 Sep 23.
  73. DeFriend DE, Dubbins PA, Hughes PM. Sacculation of the uterus and placenta accreta: MRI appearances. Br J Radiol 2000;73:1323-1325.
  74. Maldjian C, Adam R, Pelosi M, et al. MRI appearance of placenta percreta and placenta accreta. Mag Reson Imaging 1999;17:965-971.
  75. Ito T, Katagiri C, Ikeno S, Takahashi H, et al. Placenta previa increta penetrating the entire thickness of the uterine myometrium: ultrasonographic and magnetic resonance imaging findings. J Obstet Gynaecol Res 1999;25:303-307
  76. Linee guida SIEOG. Ed. 2015.
  77. Warshak CR, Eskander R, Hull AD, et al. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol 2006;108:573.581.
  78. Palacios-Jaraquemada JM. Efficacy of surgical tecniques to control obstetric hemorrhage: analysis of 539 cases. Acta Obstet Gynecol Scand 2011;90:1036-1042.
  79. Cali G, Giambanco L, Vallone M, et al.. Placenta accreta: multidisciplinary management improves maternal outcome. International Journal of Gynecology and Obstetrics 10/2012; 119:S357-S358.
  80. Timor-Tritsch IE, Monteagudo A, Cali G, Palacios- Jaraquemada JM, Maymon R, Arslan Alan A, Patil N, Popiolek D, Mittal KR. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound in Obstetrics and Gynecology 04/2014;43(4).
  81. Timor Tritsch IE, Monteagudo A, Cali G, Vintzileos A, Viscarello R, Al Khan A, Zamudio S, Mayberry P, Cordoba MM, Dar P. Cesarean scar pregnancy is a precursor of morbidly adherent placenta. Ultrasound in Obstetrics and Gynecology 09/2014;44(3).
  82. Timor-Tritsch IE, Monteagudo A, Cali G, Viscarello R, Mayberry P, Vintzileos A, Al-Khan A, Zamudio S, Dar P. Sonographically-proven Caesarean scar pregnancies (CSP) can result in a live offspring and morbidly adherent placenta (MAP). Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):178-178.
  83. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. Cesarean scar pregnancy. Ultrasound Obstet Gynecol 2003;21:310.
  84. Jurkovic D, Hillaby K, Woelfer B, Lawrence A, Salim R, Elson CJ. First-trimester diagnosis and management of pregnancies implanted into the lower uterine segment Cesarean section scar. Ultrasound Obstet Gynecol 2003;21:220-207.
  85. Rotas MA, Haberman S, Levgur M. Cesarean scar ectopic pregnancies: etiology, diagnosis, and management. Obstet Gynecol 2006;107:1373-1381.
  86. Rosen T. Placenta accreta and cesarean scar pregnancy: overlooked costs of the rising cesarean section rate. Clin Perinatol 2008;35:519-529.
  87. Norwitz ER. Defective implantation and placentation: laying the blueprint for pregnancy complications. Reprod Biomed Online 2006;13:591-599.
  88. Kliman HJ, Feinberg RF, Haimowitz JE. Human trophoblastendometrial interactions in an in vitro suspension culture system. Placenta 1990;11:349-367.
  89. Giambanco L, Doveri T, Amico ML, Forlani F, Incandela D, Alio L, Cali G. Scar pregnancies: early diagnosis allows conservative non surgical management. Supplement to International journal of gynecology and obstetrics 10/2012; 119(3):261-530.
  90. Timor Tritsch IE, Cali G, Monteagudo A, Ramos J, Berg RE, Forlani F. The use of a Foley balloon catheter as an adjuvant in treating Caesarean scar (CSP) and cervical pregnancies (CxP). Ultrasound in Obstetrics and Gynecology 09/2014; 44(S1):308-308.
  91. Timor Tritsch IE, Cali G, Monteagudo A, Khatib N, Berg RE, Forlani F, Avizova E. Foley balloon catheter to prevent or manage bleeding during treatment for cervical and Cesarean scar pregnancy. Ultrasound in Obstetrics and Gynecology 10/2014;46(1).
  92. Timor-Tritsch IE, Cali G, Monteagudo A, Berg R, Forlani F. The adjuvant, hemostatic use of a foley balloon catheter in the treatment of cesarean scar and cervical pregnancies. Ultrasound in Medicine and Biology 04/2015;41(4):S59.
  93. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol 2012;207:14-29.
  94. Timor-Tritsch IE, Monteagudo A, Santos R, Tsymbal T, Pineda G, Arslan AA. The diagnosis, treatment, and follow-up of cesarean scar pregnancy. Am J Obstet Gynecol 2012;207:44 e1- e13.
  95. Timor-Tritsch IE, Monteagudo A, Cali G, El Refaey H, Arslan AA. How to avoid misdiagnosis of cesarean scar pregnancy: an easy and reliable method for sonographic differentiation of the 5-10 completed weeks intrauterine and cesarean scar pregnancies. (in press).
  96. Alio L, Giambanco L, Alio W, Doveri T, Incandela D, Cali G. Cervical pregnancy in a nulliparous woman: case report.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.