Clinical and Radiological Features Associated with Bladder Invasion and Need for Urological Intervention in Suspected Placenta Accreta

Purpose: We investigated clinical and radiological predictors of bladder invasion and need for urological intervention in pregnant women with suspected placenta accreta. Methods: We conducted a retrospective study including pregnant women with ultrasonographic (US) suspicion of placenta accreta. Surgical and clinical data were reviewed, and seven US parameters were used to classify the patients. A single and expert radiologist reviewed Magnetic Resonance Imaging (MRI) and used nine parameters for classification. Chi-square, Fisher´s exact test or Mann-Whitney and logistic regression were used to calculate the risk of bladder invasion and need of cystorrhaphy for continuous variables. Results: Twenty-seven patients fulfilled all the inclusion criteria, and the histological diagnosis of placenta accreta, increta or percreta was performed in 5, 8 and 14 patients respectively. Regarding clinical data, the risk of placenta percreta increases 35.7% for each maternal year and three times for each cesarean section. Bilateral prophylactic double J catheter was attempted in all patients, but successful in 81,48%, mostly in percreta patients. There were signs of bladder invasion in 9 patients, all with placenta percreta. The risk of bladder injury suture increases by 26.41% for each maternal year, in the same way, increase 5.7 times for each cesarean section. Conclusion: Maternal age and number of cesareans are the only direct predictors of the depth of placental invasion and risk of urological intervention. None US or MRI parameters had a predictive role in the depth of invasion or to the risk of cystorrhaphy.