الفهرس 
PlacentaOnly 14 pages are availabe for public view
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Abstract
The word placenta accreta spectrum disorders (PASD) means an atypical
implantation of the placenta into the uterine wall. There are three forms; placenta accreta,
increta and percreta; present a significant obstetric challenge, at times resulting in lifethreatening bleeding and/or peripartum hysterectomy. The increasing rate of Cesarean
section (CS) deliveries correlates with the rising incidence of PASD. Prenatal diagnosis
of PASD and its variants can help to reduce maternal/fetal morbidity and mortality by
allowing us to choose the best time and place of birth. Multidisciplinary surgical
management is mandatory in these cases.
The aim of the study was to evaluate the diagnostic performance of 3D-power
Doppler in the prenatal diagnosis of PASD versus grayscale and color Doppler
ultrasonography as well as predicting the surgical outcome regarding the intra operative
morbidities and mortality; antenatal detection of PASD allow surgeon to prepare the
pregnant woman for surgery properly, decrease maternal and fetal morbidity and
mortality, detection site and time of delivery, counseling and an informed written consent,
informed MDT, preoperative preparation of packed RBCS, planning the surgical
technique, intra-operative management and post-operative care.
Antenatal ultrasound is the method of choice used to establish diagnosis and direct
clinical management. It is highly accurate when done by a skilled and experienced
sonographer. Grayscale and color Doppler US findings included loss of retroplacental
hypoechoic zone, multiple and abnormal placental lacunae, myometrial thinning less than
1mm, vascular lacunae and lower uterine segment hypervascularity. After using 3Dpower Doppler ultrasonography; better results were obtained.
We can summarize results of study as following:
Regarding to accuracy of grayscale and color Doppler US in diagnosis of PASD:
Myometrial thickness less than 1mm (Disruption of uterine serosa interface),
sensitivity and specificity were 57.58% and 77.94% respectively, PPV was 83.87% and
NPV was 48.18%.
Absence of retroplacental hypoechoic zone parameter’s sensitivity and specificity
were 73.13% and 69.63% respectively, PPV was 54.44% and NPV was 83.93%.
Number of lacunae more than 4 sensitivity and specificity were70.59% and 74.24% respectively, PPV was 58.54% and NPV was 83.05%.
Presence of lower uterine segment hypervascularity parameter’s sensitivity and specificity were 88.24% and 90.91% respectively, PPV was 83.33% and NPV was
93.75%.