الفهرس 
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Abstract
PA is a clinical and diagnostic challenge that is being with increasing
frequency and may lead to catastrophic blood loss and related complications and
even maternal death. Clinicians should be aware of the clinical issues, risk factors,
and imaging findings associated with PA to facilitate better case management;
subsequently decreasing maternal mortality and morbidity.
The aim of this study is to evaluate the diagnostic value of color Doppler
and gray scale ultrasonography in Prenatal Diagnosis of Placenta Accreta.
The current study was performed on 40 pregnant women (from 32 to 40
weeks of pregnancy) with placenta previa and presented with manifestations of
suspected placenta accreta during the period from October 2015 till December
2016. Thirty five Patients were referred from department of obstetrics and
gynecology of Menoufiya University Hospitals and 5 patients from Cairo
University hospital to be evaluated at ultrasound and MRI units of Radiology
department of Menoufiya University Hospitals and Cairo University hospitals.
Each patient in this study was subjected to:
1. History taking.
2. Ultrasound examination was performed using 2D and color Doppler
ultrasound equipment with a 5MHz trans-abdominal transducer.
3. MRI scan has been done after ultra sound examination to 33 patients.
The patients in our study, their age ranged from 19 to 40 years with mean age of
31.8 years, gestational age ranged from 32 to 39 week with mean of 34 week.
History of prior uterine surgery as (cesarean section and/ or D& C) was elicited in
95 % of cases 38 out of 40.
Cases diagnosed of having placenta accreta were 18 out of 40 cases (45 %); all
of them had previous uterine surgeries. Among those 18 cases; placenta found to
be accreta in 6 patients, increta in 7 patients and percreta in 5 patients.
Thirteen cases out of those eighteen (72.2 %) have had cesarean hysterectomy
and one of those 13 done partial cystectomy with cesarean hysterectomy.
Our study showed high statistical significance between occurrence of PA &
prior uterine surgeries as a risk factor (the more the number of prior surgeries, the
more the degree of placental invasion). There was also a significant relationship
between PA & cesarean hysterectomy as a complication of P value = 0.008.
Overall accuracy of US was 88%, while that of MRI was 85%. US showed
better specificity (86%) than that of MRI (81%), but MRI showed better sensitivity
(92%) than that of US (89%).
from grayscale analysis thinning of myometrium ≤1 mm shows highest
predictivity of 100%. from color Doppler analysis Aberrant crossing vessel shows
highest predictivity of 100%. from MRI analysis Dark bands in T2 shows highest
predictivity of 100%.
from this study we concluded that:
1. US is the best initial screening imaging modality for the placental invasion.
2. Color Doppler aids in the diagnosis of PA because its highlights areas of
increased vascularity with dilated blood vessels that cross the placenta and
uterine wall.
3. US is better in specificity of PA than MRI.
4. The main obstacles for US diagnosis of PA are posterior placenta, placenta
in twins and marked maternal obesity which is a common association with
pregnancy.
5. MRI provides better information on depth of invasion into myometrium and
the presence of parametrial invasion which results in modifications of
surgical techniques.
6. MRI is more clearly depict posterior placenta, placenta in twins and with
marked maternal obesity which is difficult to be evaluated by US.
7. MRI has a low specificity as it overestimates myometrial thinning.
myometrium becomes significantly thinned, often diffusely, in the late third
trimester. Thus, imaging in the second trimester or early third trimester is
preferred.