From: Collins SL, Ashcroft A, Braun T, Calda P, Langhoff-Roos J, Morel O, et al. Proposal for standardized ultrasound descriptors of abnormally invasive placenta (AIP). Ultrasound Obstet Gynecol. 2016;47(3):271-5.
Bladder wall interruption is another sign generated by the neovascularity seen on the surface of the serosa. It can appear as pairs of hyperechoic lines (sometimes referred to as the ‘= sign’) running parallel to the uterine serosa and posterior bladder wall. This is generated by the ultrasound being reflected from both walls of the vessel producing an ‘= sign’ or a scalloped appearance.
From A simple guide to ultrasound screening for placenta accreta spectrum for improving detection and optimizing management in resource limited settings. Adu-Bredu T. K. , Rijken M. J., Nieto-Calvache A.J., Stefanovic V., Aditya Aryananda R., Fox K.A. , Collins S. L. Int J Gynecol Obstet. 2022;00:1–10.