Abstract
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Define placenta accreta spectrum (PAS).
Recognize the risk factors and sonographic features of PAS.
Describe the treatment options for PAS.
Overall rates of maternal morbidity associated with placenta accreta spectrum are reported to be _______. A. 10% - 15% B. 16% - 23% C. 24% - 67% D. 70% - 80%
The magnitude of risk for placenta accreta spectrum is directly proportional to which risk factor? A. Placenta previa B. The number of cesarean sections C. Maternal age at delivery D. Pregnancy interval < 12 months
For this literature review, how many publications were found to be suitable for inclusion in the evaluation? A. 77 B. 305 C. 382 D. 459
In the 1990s, the incidence of PAS was thought to be 1 in 2,500. What are the most recent estimates for the incidence of PAS? A. 1 in 50 – 1 in 100 B. 1 in 150 – 1 in 250 C. 1 in 300 – 1 in 550 D. 1 in 600 – 1 in 800
According to a multi-center study, a third cesarean delivery is associated with a PAS prevalence of _______. A. .24% B. .3% C. .42% D. .57%
What is the percentage of risk of PAS in a patient with three prior cesarean deliveries and a placenta previa? A. 25% B. 40% C. 50% D. >50%
Esh-Broder et al. observed a ___________ of PAS associated with in vitro fertilization (IVF) compared with women who conceived spontaneously. A. 13-fold higher risk B. 15-fold higher risk C. Slightly increased risk D. Reduced risk
Which imaging modality is recommended as a first-line approach to the diagnosis of PAS? A. Contrast-enhanced CT B. Non-contrast MRI C. Grayscale and color Doppler sonography D. PET
What is the reported sensitivity and specificity of sonography with color Doppler supplementation? A. 12-15% and 35-45% respectively B. 25-35% and 50-60% respectively C. 40-50% and 65-70% respectively D. 82-100% and 70-100% respectively
The sonographic features that enhance the clinical diagnosis of PAS include _________. A. An absence of a clear interface between the uterine surface of the placenta and the myometrium B. Thicker anterior myometrium compared to the posterior myometrium C. A “swiss cheese” appearance of the anterior myometrium D. Absent vascularity in the anterior myometrium when evaluated with color Doppler
In addition to increased vascularity, which finding seen on MRI suggests the existence of PAS? A. Hypotense signal return of the anterior myometrium B. Hypertense signal return of the anterior myometrium C. Placental “bulge” D. Decreased amniotic fluid volume
In Table 1, what classification system was used to define the grade of lacunae found in the placenta in a case of PAS? A. Feinberg and Williams classification B. Stein and Leventhal C. Chaoui and Jeanty classification D. Boston classification
According to the placenta accreta index (PAI), what value is used as a cutoff to predict unfavorable versus favorable for placental invasion? A. 2 B. 3 C. 4 D. 5
The most agreed upon gestational age for recommended delivery in the setting of PAS is __________. A. 39 weeks B. 36 weeks C. 34 weeks D. 32 weeks
The most common surgical treatment for PAS is _________. A. A cesarean hysterectomy with placenta left in situ B. D & C following a vaginal delivery C. The termination of pregnancy D. Photoablation of bridging placental vessels