الفهرس 
INTRODACTION
The PlacentaOnly 14 pages are availabe for public view
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Abstract
The morbidly adherent placenta (accreta, increta, and percreta) has emerged as a significant obstetric challenge over the last decade. Once a rare diagnosis, (Hertig 2005) morbidly adherent placenta now complicates as many as 1 per 500 pregnancies. (Wu et al., 2005) Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. (Grosvenor et al., 2006)
The aim of our study to early predict and diagnose placenta accreta in pregnant women to prepare and receive proper management outlines.
The study was conducted at Women’s Health Hospital, Assiut University.
The study involved 100 cases of placenta previa delivered at Women’s Health Hospital, Assiut University from August 2016 to August 2017
Study Design is Prospective descriptive study.
All included women in our study will be under the score called placenta accreta index score which include 5 parameters and values:
Values Parameters
3 ≥ 2 cesarean section 1
3.5
1 Lacunae
Grade 3 (> 6)
Grade 2 (4-6) 2
1
0.5
0.25 Smallest myometrial thickness
≤ 1 mm
1-3 mm
> 3 mm ≤ 5 mm 3
1 Anterior placenta previa 4
0.5 Bridging vessels 5
(Rac MWF, et al., 2014)
Our outcomes were to detect rate of morbidly adherent placenta in relation to placenta accreta index scoring and to evaluate the accuracy of PAI in diagnosis of morbidly adherent placenta, Amount of blood and fluids needed, any complications in cases of conservative management.
It was found that placenta accreta significantly increased, with increase No. of previous C.S., anterior placenta previa, increase grading of placental lacunae, presence of bridging vessels, and with smaller myometrial thickeness.
According to PAIS It was found that cut off point for diagnosis of placenta accrete was >5.25, with sensitivity 86% specificity 88%.
It was found that there is a significant impact of PAIS in diagnosis of placenta accrete.
50 of 100 cases were diagnosed as placenta accrete with mean PAIS 7.12, where the other 50 cases were diagnosed as placenta previa with mean PAIS 3.63.
As regarding, duration of operation there were significant difference in duration of operation which is longer in placenta accreta cases with higher PAIS.
It was found that there is significant difference in blood transfusion, which is more in cases of placenta accrete with higher PAIS.
There was An increase rate of caeserean hysterectomy in cases of placenta accrete with higher PAIS.
Points of strength:
• Study was prospective cohort study
• Follow up Patients with different PAIS either previa or accrete as regarding type of surgery radical vs conservative management, duration of operation, need for blood transfusion to support the diagnosis.
Limitation
• Need for larger sample size
• The possible progression of placenta accrete needs further evaluation for proper timing of intervention
• Need to include cases in early pregnancy with follow up PAIS through different trimesters.
Conclusion
It was found that a score derived from the ultrasound parameters of smallest myometrial thickness, lacunar spaces, and presence of bridging vessels, in addition to the number of prior cesarean deliveries and placental location, was highly predictive of placental invasion among pregnancies at increased risk.
The application of the Placenta Accreta Index can be helpful in stratifying individual risk of invasion above the a priori risk based on number of prior cesarean deliveries and placental location.
It may be used for counseling and preoperative planning, by either heightening awareness for morbidly adherent placenta or providing reassurance to a woman who desires future fertility. It may also play a role in identifying women who may benefit from referral to a tertiary center that has sufficient blood bank capacity and multidisciplinary services.