Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation

Volkov A.E., Solonchenko A.S., Rymashevsky A.N., Voloshin V.V., Khloponina A.V., Kantsurova M.R.

1) Rostov State Medical University, Ministry of Health of Russia, Rostov-on-Don, Russia; 2) Perinatal Center, Rostov-on-Don, Russia

Background: Placenta accreta spectrum (PAS) is an advanced invasive placentation, which is a serious condition associated with high maternal mortality due to massive uterine hemorrhages. These complications can be reduced by early diagnosis of PAS.
Case report: A 35-year-old multiparous patient with a burdened obstetric and gynecological history had indirect signs of abnormally deep invasion of the chorion which were revealed during ultrasound examination at 7+1 weeks gestation. The ultrasound scan showed a heterogeneous structure with the expansion of lacunar spaces and areas of hypervascularization of the myometrium of the anterior uterine wall. The diagnosis of abnormal placental attachment was confirmed by dynamic echography with stereoscopic blood flow imaging (LumiFlow). A planned cesarean section by transverse uterine fundal incision was performed at 37+2 weeks. Metroplasty was performed on both sides after ligation of the internal iliac and ovarian arteries. The diagnosis of PAS was confirmed by a pathology study, and placenta increta (PAS 3a) was verified.
Conclusion: The presented clinical observation clearly demonstrates the real possibility of early ultrasound diagnosis of advanced invasive placentation. The detection of signs of advanced invasive placentation at the earliest possible time of gestation suggests that patients can be referred to a high-risk PAS group for the subsequent search for specific signs of this placental pathology and optimal planning of organ-preserving methods of delivery in these patients.

Authors’ contributions: Volkov A.E. – developing the concept and design of the study, obtaining the data, their analysis and interpretation, writing the text of the article, surgical treatment of the patient; Solonchenko A.S. – ultrasound diagnosis of the case in early pregnancy; Rymashevsky A.N. – developing the concept and design of the study, scientific editing of the text, surgical treatment of the patient, Voloshin V.V. – carrying out morphological research, editing the obtained data, writing the text; Khloponina A.V. – echography of a case in late pregnancy, Kantsurova M.R. – management of the patient in the postoperative period.
Conflicts interest: The authors declare that there are no conflicts of interest.
Funding: The investigation has not been sponsored.
Ethical Approval: The study was approved by the Ethical Review Board of the Rostov State Medical University, Ministry of Health of the Russian Federation, Rostov-on-Don.
Patient Consent for Publication: The patient provided informed consent for the publication of her data and associated images.
For citation: Volkov A.E., Solonchenko A.S., Rymashevsky A.N., Voloshin V.V., Khloponina A.V., Kantsurova M.R. Early diagnosis of abnormally deep invasion of the chorion as a predictor of invasive placentation.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (3): 180-186 (in Russian)


abnormal chorionic invasion
placenta accreta spectrum


  1. Jauniaux E., Collins S., Burton G.J. Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am. J. Obstet. Gynecol. 2017; 218(1): 75-87. https://dx.doi.org/ 10.1016/j.ajog.2017.05.067.
  2. Silver R.M. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet. Gynecol. 2015; 126(3): 654-68. https://dx.doi.org/10.1097/ AOG.0000000000001005.
  3. Fitzpatrick K.E., Sellers S., Spark P., Kurinczuk J.J., Brocklehurst P., Knight M. Incidence and risk factors for placenta accreta/increta/percreta in the UK: a national case-control study. PLoS One. 2012; 7(12): e52893. https://dx.doi.org/10.1371/joumal.pone.0052893.
  4. Шмаков Р.Г., Баев О.Р., Пекарев О.Г.. Пырегов А.В., Приходько А.М., Павлович С.В. Кесарево сечение: показания, хирургическая техника, методы обезболивания. Учебное пособие НЦ акушерства, гинекологии и перинатологии им. акад. В.И. Кулакова. М.: «Радуга»; 2016: 71. [Shmakov R.G., Baev O.R., Pekarev O.G., Pyregov A.V., Prikhod’ko A.M., Pavlovich S.V. Caesarean section: indications, surgical technique, methods of anesthesia. Textbook of the Scientific Centre of Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov. Moscow: Raduga; 2016: 71. (in Russian)].
  5. Say L., Chou D., Gemmill A., Tunqalp O., Moller A.B., Daniels J. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob. Health. 2014; 2(6): e323-33. https://dx.doi.oiE/10.1016/S2214-IO9X(14)7O227-X.
  6. Результаты конфиденциального аудита материнской смертности в Российской Федерации в 2016 году (методическое письмо). М.: Департамент медицинской помощи детям и службы родовспоможения Министерства здравоохранения Российской Федерации; 2017: 35. [Results of confidential audit of maternal mortality in the Russian Federation in 2016 (methodological letter). M.: Department of Medical Care for Children and Maternity Services of the Ministry of Health of the Russian Federation, 2017: 35. (in Russian)].
  7. Гус А.И., Бойкова Ю.В., Ярыгина Т.А., Яроцкая Е.Л. Современные подходы к пренатальной диагностике и скринингу врастания плаценты (обзор рекомендаций). Акушерство и гинекология. 2020; 10: 5-12. [Gus A.I., Boikova Yu.V., Yarygina T.A., Yarotskaya E.L. Modern approaches to prenatal diagnosis and screening of placenta accreta (review of recommendations). Obstetrics and Gynecology. 2020; (10): 5-12. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.5-12.
  8. Eller A., Porter T.F., Soisson P., Silver R.M. Optimal management strategies for placenta accreta. BJOG. 2009; 116(5): 648-54. https://doi.org/10.1111/j.1471-0528.2008.02037.x.
  9. Jauniaux E., Collins S.L., Jurkovic D., Burton G.J. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. Am. J. Obstet. Gynecol. 2016; 215(6): 712-21. https://dx.doi.org/ 10.1016/j.ajog.2016.07.044.
  10. Jauniaux E., Chantraine F., Silver R.M., Langhoff-Roos J.; FIGO Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO consensus guidelines on placenta accreta spectrum disorders: epidemiology. Int. J. Gynecol. Obstet. 2018; 140(3): 265-73. https://dx.doi.org/10.1002/ijgo.12407.
  11. Jauniaux E., Bhide A. Prenatal ultrasound diagnosis and outcome of placenta previa accreta after cesarean delivery: a systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017; 217(1): 27-36. https://dx.doi.org/10.1016/j.ajog.2017.02.050.
  12. Tabsh K.M., Brinkman C.R., King W. Ultrasound diagnosis of placenta increta. J. Clin. Ultrasound. 1982; 10(6): 288-90. https://dx.doi.org/10.1002/jcu.1870100610.
  13. D’Antonio F., Iacovella C., Bhide A. Prenatal identification of invasive placentation using ultrasound: systematic review and meta-analysis. Ultrasound Obstet. Gynecol. 2013; 42(5): 509-17. https://dx.doi.org/10.1002/uog.13194.
  14. Panaitova J., Tokunaka M., Krajewska K., Zosmer N., Nicolaides K.H. Screening for morbidly adherent placenta in early pregnancy. Ultrasound Obstet. Gynecol. 2019; 53(1): 101-6. https://dx.doi.org/10.1002/uog.20104.
  15. Блинов А.Ю., Гольцфарб В.М., Долгушина В.Ф. Ранняя пренатальная диагностика истинного приращения плаценты. Пренатальная диагностика. 2011; 10(1): 79-84. [Blinov A.Yu., Gol’tsfarb V.M., Dolgushina V.F. Early prenatal diagnosis of true placental increment. Prenatal Diagnosis. 2011; 10(1): 79-84. (in Russian)].
  16. Демидов В.Н., Гус А.И., Ярыгина Т.А. О возможности высокоточной диагностики врастания плаценты в рубец на матке после кесарева сечения при ультразвуковом исследовании. Пренатальная диагностика. 2020; 19(4): 336-42. [Demidov V.N., Gus A.I., Yarygina T.A. About the possibility of high-precision diagnostics of placenta ingrowth into the uterine scar after cesarean section with ultrasound examination. Prenatal Diagnosis. 2020; 19(4): 336-42. (in Russian)]. https://dx.doi.org/10.21516/2413-1458-2020-19-4-336-342.
  17. Рымашевский А.Н., Рымашевский М.А., Келлер О.В., Волков А.Е., Канцурова М.Р. Способ ушивания ложа миоматозного узла. Патент на изобретение. Номер патента: RU 2790964 C2. Патентное ведомство: Россия. Номер заявки: 2021108736. Дата регистрации: 30.03.2021. Дата публикации: 28.02.23. Патентообладатели: Ростовский государственный медицинский университет Министерства здравоохранения Российской Федерации. [Rymashevsky A.N., Rymashevsky M.A., Keller O.V., Volkov A.E., Kantsurova M.R. Method of suturing the bed of the myomatous node. Patent for the invention. Patent number: RU 2790964 C2. Patent office: Russia. Application number: 2021108736. Registration date: 30.03.2021. Publication date: 28.02.23. Patent holders: Rostov State Medical University of the Ministry of Health of the Russian Federation. (in Russian)].
  18. Cali G., Forlani F., Timor-Tritsch I.E., Palacios-Jaraquemada J., Minneci G., D'Antonio F. Natural history of Cesarean scar pregnancy on prenatal ultrasound: the crossover sign. Ultrasound Obstet. Gynecol. 2017; 50(1): 100-4. https://dx.doi.org/10.1002/uog.16216.

Received 12.02.2024

Accepted 13.03.2024

About the Authors

Andrey E. Volkov, PhD (Med.), Associate Professor, Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, avolkov@aaanet.ru, https://orcid.org/0000-0002-5899-1252
Alexey S. Solonchenko, ultrasound diagnostics doctor at the Department of Antenatal Fetal Protection, Rostov Regional Perinatal Center, 344068, Russia, Rostov-on-Don, Bodraya str., 90, +7(863)235-50-18, a-solonchenko@mail.ru, https://orcid.org/0009-0000-9971-5521
Alexander N. Rymashevsky, Dr. Sci. (Med.), Professor, Head of the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia, Rostov-on-Don, lane. Nakhichevan Lane, 29, +7(863)234-24-23, rymashevskyan@mail.ru, https://orcid.org/0000-0003-3349-6914
Vladimir V. Voloshin, PhD (Med.), Associate Professor, Rostov State Medical University, Ministry of Health of Russia, 344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, voloshinvv2006@yandex.ru, https://orcid.org/0000-0001-8632-082X
Anna V. Khloponina, Dr. Sci. (Med.), Head of the Department of Ultrasound Diagnostics of NIIAP, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)201-44-31, annakhloponina@yandex.ru, https://orcid.org/0000-0002-2056-5231
Maria R. Kantsurova, Assistant at the Department of Obstetrics and Gynecology No. 1, Rostov State Medical University, Ministry of Health of Russia,
344022, Russia, Rostov-on-Don, Nakhichevan Lane, 29, +7(863)234-24-23, madlax_san@mail.ru, https://orcid.org/0000-0003-4916-8042
Corresponding author: Andrey E. Volkov, avolkov@aaanet.ru

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