Abstract
Objective: To compare the accuracy of different ultrasonographic modalities; two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.
Highlights
Adherent placenta, including placenta accreta, placenta increta, and percreta, occurs as a result of placental villi penetrating the myometrium through a defect in the decidua basalis
All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included
One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta
Summary
Adherent placenta, including placenta accreta, placenta increta, and percreta, occurs as a result of placental villi penetrating the myometrium through a defect in the decidua basalis. It is a major cause of obstetric hemorrhage and is associated with increased maternal morbidity and mortality [1]. The incidence of placenta accreta has increased with the rising number of cesarean deliveries. The risk of placenta accreta is 3%, 11%, 40%, 61% and 67% for the first, second, third, fourth and fifth or greater repeat cesarean deliveries, respectively [4]. Besides advanced maternal age and multiparity, reported risk factors include any condition resulting in myometrial tissue damage followed by a secondary collagen repair, such as previous myomectomy, and endometrial defects due to vigorous curettage resulting in Asherman syndrome [5], submucous fibroids, thermal ablation [6], and uterine artery embolization [7]
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