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Ultrasound-histopathologic features of the utero-placental interface in placenta accreta spectrum

Jauniaux, E; Zosmer, N; Subramanian, D; Shaikh, H; Burton, GJ; (2020) Ultrasound-histopathologic features of the utero-placental interface in placenta accreta spectrum. Placenta , 97 pp. 58-64. 10.1016/j.placenta.2020.05.011. Green open access

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Abstract

INTRODUCTION:The objective of this study was to evaluate the relationship between utero-placental vascular changes on ultrasound imaging and histopathologic findings according to the grade of villous invasion in placenta accreta spectrum (PAS). METHODS: The ultrasound features of 31 patients with singleton pregnancies diagnosed prenatally with low-lying/placenta previa accreta were compared with histopathology findings following caesarean hysterectomy (n = 25) or partial myometrial resection (n = 6). The number and degree of transformation of arteries within the superficial layer of myometrium were recorded. Cytokeratin 7 (CK7) immunohistochemistry was used to complement H&E analysis. RESULTS: All 31 patients presented with loss of clear zone, myometrial thinning and placenta lacunae. Subplacental hypervascularity and lacunae feeder vessels were found in 25 and nine cases, respectively. Large recent intervillous thromboses were found in one case with adherent villi and 12 cases with invasive villi, and showed a significantly different distribution according to lacunae scores. Thick basal plate fibrinoid deposits were found in all the areas of abnormally adherent and invasive villous tissue There was no significant difference in the mean count of partially remodeled vessels or vessels completely lacking remodeling according to the lacunae score and grade of placental invasiveness. EVT cells were arranged in superficial confluent sheets or superficial irregular clusters, or were scattered deep below the basal plate. CONCLUSION: Placental ultrasound and histopathologic features associated with PAS are more pronounced in invasive cases suggesting that they are secondary to the haemodynamic effects of abnormally deep placentation and transformation of the radial and arcuate arteries.

Type: Article
Title: Ultrasound-histopathologic features of the utero-placental interface in placenta accreta spectrum
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.placenta.2020.05.011
Publisher version: https://doi.org/10.1016/j.placenta.2020.05.011
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher's terms and conditions.
Keywords: Placenta accreta, Invasive placenta, Placenta increta, Uterinescar, Placental basal plate, Uterine vasculature
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Reproductive Health
URI: https://discovery.ucl.ac.uk/id/eprint/10110761
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