Accuracy of 2D Greyscale and 2D and 3D Color Power Doppler Ultrasound in the Diagnosis of Morbidly Adherent Placenta (MAP)

Abstract

Background Prenatal diagnosis of placental accreta (PA) is essential to carry out adequate surgical planning in centers where multidisciplinary teams are in place, which improve results and reduce complications. These ideal scenarios should be developed in countries with more significant difficulties in the availability of human and technological resources, through teamwork in the different hospital centres and the adequate transfer of patients at higher risk to centres with the best interdisciplinary management skills. Objective To evaluate the diagnostic accuracy of each sign (2D grayscale US signs), 2D Doppler signs, and 3D Doppler signs modified from Collins SL in diagnosis of morbidly adherent placenta in patients with one or more previous cesarean section diagnosed as placenta previa. Methods The present study is a diagnostic test accuracy study was carried out at Ain Shams University Maternity Hospital during the period from January 2020 to March 2021. 126 women were recruited from Special Care Center of the fetus – Ain Shams University Maternity Hospital. All included women were scanned by 2D grayscale, 3D power Doppler ultrasound. Results The current study showed that cases underwent cesarean hysterectomy had significantly higher previous cesarean sections. The results of the current study showed a significant association between all criteria of the 2D grayscale, Color Doppler, 3D Power Doppler ultrasound and presence of placental adherence, considerable intraoperative blood loss, need for added surgical steps, CS hysterectomy and bladder injury with the presence of more than 4 sign or more are predictive for placental invasion with the need of emergency hysterectomy. Conclusion The result of the current study proves the diagnostic accuracy of the ultrasound concerning the prediction of difficult placental separation, considerable intraoperative blood loss, CS hysterectomy and bladder invasion.