BACKGROUND:Uterine myomas encountered at cesarean delivery increase the complexity and risk of the procedure. Preoperative planning of such deliveries may help optimize patient outcomes. The application of three-dimensional printing technology is rapidly expanding in many surgical specialties. We created a three-dimensional-printed model from the magnetic resonance images (MRIs) of a gravid uterus with multiple myomas for surgical planning of cesarean delivery.INSTRUMENT:A three-dimensional-printed uterine model from MRIs of a pregnant patient with multiple uterine myomas as a tool for planning cesarean delivery.EXPERIENCE:A 33-year-old woman with a myomectomy history presented to our institution for prenatal care. Initial ultrasound imaging revealed multiple uterine myomas. A three-dimensional-printed uterine model, based on subsequent MRI, was created for presentation at an obstetric multidisciplinary meeting. The model accurately represented the number, size, and locations of uterine myomas, aiding surgical planning, including skin and uterine incisions. At the time of cesarean delivery, the model was directly correlated with patient anatomy to further determine the optimal placement of uterine incision. Maternal and fetal outcomes were excellent.CONCLUSION:Three-dimensional-printed models, through improved surgical planning, could optimize outcomes for patients with uterine myomas undergoing cesarean delivery.

Philip S. Lim, Amy M. Mackey, and Monica L. HuangThis chapter will begin with a description of the normal placenta, then focus mostly on MR imaging of placenta accreta, and finally review some non-obstetric etiologies of abdominal pain in pregnancy. Fetal anomalies will not be included in this chapter.

OBJECTIVE The purpose of this study was to evaluate transabdominal pelvic ultrasound and MRI for the prenatal diagnosis of placenta accreta. MATERIALS AND METHODS A historical cohort pilot study was performed at our institution to identify women at risk of placenta accreta who had undergone both prenatal ultrasound and MRI. Findings at ultrasound and MRI were compared with the final diagnosis, which was established with clinical findings at delivery and pathologic examination of specimens. Volume measurements were made of low-signal-intensity intraplacental bands on T2-weighted MR images. Risk factors for placental insufficiency were recorded. RESULTS Thirteen patients at risk of placenta accreta underwent both sonography and MRI. Nine of these patients had abnormal placentation. With ultrasound, abnormal placentation was correctly identified in six of nine patients (67%) and the absence of accreta in two of four patients (50%). With MRI, abnormal placentation was correctly identified in seven of nine patients (78%) and the absence of accreta in three of four patients (75%). The volumes of low-signal-intensity bands were significantly different in the patients with abnormal placentation and those without placenta accreta (p = 0.047), and band volumes were significantly different among patients with accreta, increta, and percreta (p < 0.0005). CONCLUSION The accuracy of MRI may improve if volumes of low-signal-intensity bands are calculated, MRI is performed before 30 weeks' gestation, and risk factors for placental insufficiency are recognized.