PMC

28 year old primipara with placenta increta after methotrexate administration, 19th post-natal day - transabdominal sonography. 3A: Sagittal section (Siemens-Antares; 3.5MHz probe) showing increased echogenicity of placenta. Red arrow shows echogenic placental mass and white arrow points to the myometrium. 3B: Color Doppler (Siemens Antares; 3–5 MHz probe) showing decreased blood flow to the placenta (cross section). 3C: Power Doppler (Siemens Antares; 3–5 MHz probe) showing reduced blood flow to the echogenic placental mass

28 year old primipara with placenta increta transabdominal songhraphy after expulsion of placenta (36th post-natal day). 4A: Pulsed Doppler shows normal blood flow in the uterus (Siemens Antares; 3–5 MHz probe). 4B: T2 weighted MRI sagittal image (TR 7210 TE 95; Siemens Avanto 1.5 Tesla MRI). White arrow points to the empty uterine cavity. 4C: T2 weighted MRI coronal image (TR 4181 TE 109; Siemens Avanto 1.5 Tesla MRI). White arrow points to the empty uterine cavity

28 year old primipara third post natal day - with Postpartum haemorrhage. Transabdominal sonography prior to methotrexate administration. 1A: Ultrasonography; longitudinal section of uterus showing placental invasion in to the myometrium (red arrows). The echogenecity of placental invasion is almost similar to that of myometrium. (Siemens Antares -3–5 mega Hz curvilinear transducer) 1B showing persistent increased blood flow at the fundus with the retained placenta. (Siemens Antares Color Doppler with 3–5 mega Hz) 1C: Power-Doppler showing blood flow at the fundus of uterus and placental mass (Siemens Antares 3–5 MHz convex probe)

28 year old primipara with adherent placenta - 12th postnatal day.
2A1: pre contrast T2 weighted MRI sagittal image (TR 5464 TE 44; 1.5 Tesla Siemens Avanto-TIM machine, Germany, using pelvic phased array coil; matrix 320×640 FOV 26×26). Red arrow shows the hyperintense placenta invading the myometrium almost up to the serosa at this part of the uterus. White arrow shows the plane of placenta at myometrium sparing the deep myometrial layer corresponding to accreta. 2B1: pre contrast T2 weighted tirm MRI coronal image (TR 7911 TE 44 TI 160; Siemens Avanto 1.5 Tesla MRI). Red arrows point to the hyperintense lesion corresponding to the retained placental tissue. The hyperintense placental tissue is invading more than 50% of the myometrial thickness consistent with increta. 2C1: Pre contrast T2 weighted TRUFI MRI axial image (TR 2.82 TE 1.2; Siemens Avanto 1.5 Tesla MRI). Red arrows point to the hyperintense lesion corresponding to the retained placental tissue.
2A2: Post-natal day- post Gadolinium contrast venous phase T1 weighted fat suppressed MRI sagittal image (TR 319 TE 2.5; Siemens Avanto 1.5 Tesla MRI; 8 ml of Gadolinium). Red arrows point to the irregular heterogenous intense enhancement of the placenta and its invasion through myometrium upto the serosa in the fundus of the uterus. White arrow points to the hyperintense placenta abutting the superficial layer of myometrium. 2B2: Post Gadolinium venous phase T1 weighted fat suppressed MRI coronal image (TR 3.2 TE 1.1; Siemens Avanto 1.5 Tesla MRI). Red arrow points to the intensely enhancing lesion corresponding to the retained placental tissue. 2C2: Post Gadolinium venous phase T1 weighted MRI axial image (TR 270 TE 4.76; Siemens Avanto 1.5 Tesla MRI). Red arrow points to the intensely enhancing lesion corresponding to the retained placental tissue and white arrow to the lesser intense surrounding myometrium.