0:00

This is an MRI of the abdomen and pelvis

0:02

in a patient who was referred from

0:04

Maternal-Fetal Medicine Clinic for an

0:06

abnormal obstetric ultrasound at 28 weeks.

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Again, we've placed our steady-state

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free precession images on the left and

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our turbo spin echo images on the right.

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As we scroll down, the gravid

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uterus comes into view.

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We can nicely visualize the T2

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heterogeneous myometrium on all

0:25

sides near the fundus of the uterus.

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As we scroll inferiorly, particularly on the

0:32

turbo spin echo sequences, we can see that this

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patient's placenta is particularly low-lying.

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It's really occupying the majority

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of the lower uterine segment and

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paracervical region for this patient.

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Again, we see features of placenta accreta

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spectrum with T2 dark placental bands,

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placental heterogeneity, and a relatively

0:54

lobular appearance of the placenta.

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I'd like to point out that for this

0:59

patient as well, that as we scroll

1:02

inferiorly, it becomes more and more

1:04

difficult to discern any myometrium.

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Particularly posteriorly for this patient,

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we can see that there is placental tissue

1:14

that is bulging in the region of the

1:16

cervix and upper one third of the vagina.

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And we see numerous engorged vessels in

1:23

the left hemipelvis for this patient.

1:26

These are coronal T2-weighted images of the

1:28

abdomen and pelvis for the same patient.

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Again, we see a low-lying,

1:34

heterogeneous placenta with thinning

1:37

of the overlying myometrium.

1:40

There is, in some places, there are in some

1:45

places, areas where it seems that the placenta

1:48

is directly abutting the dome of the bladder.

1:51

And again, this placenta is heterogeneous.

1:54

It's not as lumpy-bumpy as some of the

1:56

other placentas that we've seen, but

1:58

there are certainly features of placenta

2:02

accreta spectrum present with placental

2:03

bands and heterogeneity, as well as

2:05

the abnormal position of the placenta.

2:09

Lastly, these are sagittal T2-weighted

2:10

images of the pelvis in this patient.

2:12

We can see that this patient

2:13

has a complete placenta previa.

2:16

This is the anterior lip and

2:17

posterior lip of the cervix, with

2:19

the placenta sitting directly on top.

2:23

As we scroll through, again we see those classic

2:26

features of placenta accreta spectrum, multiple

2:28

large placental bands, tissue heterogeneity,

2:32

and a lobular contour of the placenta.

2:35

There are also several regions in which

2:37

it becomes difficult to distinguish the

2:40

placenta from the dome of the urinary bladder,

2:43

which is a concerning finding,

2:44

particularly in this patient with

2:46

minimal to no overlying myometrium.

2:49

And so concern was raised for placenta

2:50

percreta in this patient, which was proven

2:53

at pathology following cesarean hysterectomy.

2:57

Another salient feature of this case that I'd

2:59

like to highlight is that when we evaluate the

3:02

area of the amniotic sac surrounding the fetus,

3:04

there is little to no amniotic fluid present.

3:07

In the other cases of pregnancy that we've

3:09

evaluated thus far, we've seen amniotic fluid

3:12

as T2 hyperintense and surrounding the fetus.

3:15

And on these images, there's really

3:17

almost no amniotic fluid present.

3:19

We can see a small amount of fluid in the

3:21

cervical canal, but it was ultimately determined

3:24

that this patient had premature rupture of

3:26

membranes, which necessitated a more urgent

3:29

operative intervention for the patient.