Unit Ultrasonografi Obstetri dan Ginekologi

Departemen / SMF Obstetri Ginekologi FK Unair – RSUD Dr. Soetomo

Jl. Mayjen Prof. Dr. Moestopo No. 6 – 8

PLACENTAL MAPPING OF ABNORMALLY INVASIVE PLACENTA (AIP)

Name : Age : y.o. Medical Record:
Date : _ _/ _ _/ _ _ _ _ Gestational age : _ _ weeks _ days
Gravida _ Para _ - _ - _ - _ Mode of conception: Spontaneous IUI/ IVF
Was Caesarean scar pregnancy suspected/ diagnosed in first trimester? Yes No Not know
History of previous surgical evacuation (including TOP)/ curretage Yes No Not know
History of Previous Placenta Previa Yes No Not know
History of Abnormally Invasive Placenta (AIP) Yes No Not know
Placenta previa on ultrasound Yes No Not know
If yes: Anterior placenta previa <2 cm from internal os covering internal os
Posterior placenta previa <2 cm from internal os covering internal os
Cervical length (without funnel or placental tissue) mm
Grayscale ultrasound parameters and
Yes No Unsure
definition
Absent of retroplacental clear zone
Myometrial thinning <1 mm
Abnormal placental lacunae
Bladder wall interruption
Placental bulge
Focal exophytic mass/ Placental tissue seen
breaking through uterine serosa (filling bladder)
Color Doppler ultrasound parameters and
Yes No Unsure
definition
Uterovesical hypervascularity
Subplacental hypervascularity
Bridging vessel
Placental lacunae feeder vessel
Parametrial involvement Yes No Unsure
Suspicion of invasion into parametrium
3D Doppler Yes No Unsure
Inseparable cotyledonal and intervillous
circulations, chaotic branching, detour vessels
(lateral view)
3D Rendering ultrasound / Crystal vue Accreta Increta Percreta
Probability topography placental invasion
S1 S2 S1 – S2
Placental invasion area
3D Volume CT rendering
Placental Mapping
Right view Anterior view Left view

Result
Placental Topography Majority of Placental invasion
High suspicious of diffuse AIP Accreta
High suspicious of focal AIP Increta
Intermediate suspicious of focal AIP Percreta
Low suspicious of AIP
Uterine Vascular Involvement : S1 segment S2 segment

Terima Kasih atas konsulannya Nama Pemeriksaan (versi RSDS):

Hormat Kami,
Divisi Kedokteran Fetomaternal
FK Unair – RSUD Dr. Soetomo Surabaya
USG evaluasi plasenta akreta 2D/3D/4D
Nama Pemeriksaan (versi koding ICD):
Diagnostic Ultrasound of gravid uterus / 88.78
(mohon dituliskan di SEP pasien BPJS)