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Christopher Robinson: Diagnosis of Placenta Accreta Spectrum by the ‘Rail’ and ‘Tramline’ Signs
Christopher Robinson/LinkedIn
May 21, 2026, 12:17

Christopher Robinson: Diagnosis of Placenta Accreta Spectrum by the ‘Rail’ and ‘Tramline’ Signs

Christopher Robinson, Associate Professor Maternal Fetal Medicine at University of South Carolina, shared a post on LinkedIn:

“Images in Obstetrics: Diagnosis of placenta accreta spectrum by the ‘rail’ and ‘tramline’ signs: similar names but different techniques and topography – Rail sign: 2D ultrasound with color doppler imaging

(A) 2D sagittal ultrasound image with color Doppler bisecting the bladder/lower uterine segment and placenta showing placenta previa without signs of placenta accreta spectrum at gestational age 31 weeks. There is no color Doppler signal detected between uterovesical interface, the placenta does not bulge into the bladder, and the clear zone is preserved.

(B) 2D ultrasound with color Doppler suggestive of placenta percreta at gestational age 27 weeks showing the rail sign, with the numbers corresponding to

  1. subplacental hypervascularity
  2. uterovesical hypervascularity
  3. bridging vessels
  4. newly formed vessels on the bladder mucosa

(C) Schematic diagram explaining the rail sign describing figure 1B. Arrows are pointing to the excessive vascularity at the bladder interface, bridging vessels and newly formed blood vessels on the bladder mucosa. This leads to the appearance of 2 parallel lines (the ‘rail’), with neovascularization (or ‘bridging vessels’) appearing as the railway sleepers linking the 2 rails.”

Read more.

Title: Diagnosis of placenta accreta spectrum by the ‘rail’ and ‘tramline’ signs: similar names but different techniques and topography

Authors: Christoph C. Lees, Savitree Pranpanus, Andrea Dall’Asta, Rozi Aryananda, Jin-Chung Shih

Christopher Robinson: Diagnosis of Placenta Accreta Spectrum by the ‘Rail’ and ‘Tramline’ Signs

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Andrea Dall’Asta bladder mucosa blood vessels bridging vessels Christoph C. Lees Christopher Robinson excessive vascularity Fertility Fertility News Gestational Age Jin-Chung Shih Neovascularization Obstetrics placenta accreta spectrum rail’ and ‘tramline’ signs reproductive health Reproductive Medicine Rozi Aryananda sagittal ultrasound Savitree Pranpanus subplacental hypervascularity uterine segment uterovesical hypervascularity uterovesical interface
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