Abstract
Objective: The study’s objective was to assess the accuracy of using prenatal 3-dimensional power Doppler analysis of vascular placental indices to accurately diagnose morbidly adherent placenta objectively. Background: Traditionally, 2D ultrasound was used for the diagnosis of a suspected morbidly adherent placenta (MAP) previa. More objective techniques like 3D power Doppler haven’t been well studied. Study Design: A prospective cohort study is designed for women with gestational age between 28 and 32 weeks with suspected placenta previa. Patients were examined by 2D ultrasound which was used in management decisions. 3D Power Doppler’s VI, FI and VFI were measured during the same examination after manual tracing of placenta; data were blinded to obstetricians. Histopathology was performed to confirm MAP. Results: Our results showed that the 3D power Doppler VI ≥ 16 predicted the diagnosis of MAP with 100% sensitivity, 100% specificity which is better than those of 2D ultrasound. While VI > 33.1 measured by 3D Doppler predicted severe MAP with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound. Conclusion: In patients with placenta previa, the 3D Doppler’s vascular index accurately predicts MAP. Furthermore, vascular and vascular flow indices of 3D Doppler were more predictive of severe cases of MAP compared to 2D ultrasound.
Highlights
The placenta attaches to the wall of the uterus, sometimes the placenta invades deeply into the uterine wall that part or all of the placenta remains attached [1]
Patients were examined by 2D ultrasound which was used in management decisions. 3D Power Doppler’s vascular index (VI), FI and VFI were measured during the same examination after manual tracing of placenta; data were blinded to obstetricians
While VI > 33.1 measured by 3D Doppler predicted severe morbidly adherent placenta (MAP) with a sensitivity of 73.9% and specificity of 86.4%, which was superior to 2D ultrasound
Summary
The placenta attaches to the wall of the uterus, sometimes the placenta invades deeply into the uterine wall that part or all of the placenta remains attached [1]. The term “morbidly adherent placenta” (MAP) has been more frequently used to describe abnormal implantation of the placental villi into the uterine wall [2] It is histopathological term-occurs when the placenta fails to detach from the wall of the uterus due to abnormal implantation at the basal plate [3]. Hyper vascularity of the uterine serosa-bladder wall interface and tortuous confluent vessels across the placental width were used as diagnostic criteria for morbidly adherent placenta by Collins et al [8]. A recent study quantified the amount of vessels involved in the diagnosis of morbidly adherent placenta [9] This was applied to the utero-placental interface only and not the entire placenta. Choosing the most confluent area is operator dependent and other areas might have been missed due to subjectivity of the operator’s assessment [10]
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