Accuracy of three-dimensional multislice view Doppler in diagnosis of morbid adherent placenta

Abstract

Placenta accreta occurs when placental trophoblasts invade the endometrium beyond the Nitabuch's layer of decidua basalis, placenta increta occurs when placental trophoblasts invade the myometrium, and placenta percreta occurs when placental trophoblasts invade the serosa (1, 2). Morbid adherent placenta (MAP) is generally associated with excess blood loss, bladder injuries and hysterectomies (3, 4). The incidence of MAP has increased significantly over the last 50 years (5, 6). A past history of a cesarean delivery, placenta previa, and damage of the Nitabuch's layer of decidua basalis following intrauterine infection or scarring are the risk factors of MAP. The incidence of MAP is increased concomitantly with increased cesarean section rates (1, 7-9). The incidence of MAP is 3.3% in pregnant women with no past history of cesarean delivery and placenta previa and is 40% in pregnant women with a history of two cesarean sections and placenta previa (4). If MAP was diagnosed or suspected before delivery, the optimum time for planned delivery is around 34-35 weeks, following a course of corticosteroids and multidisciplinary team care approach (2, 10, 11). An accurate diagnosis of MAP is essential to prepare both the patient and health providers for possible complications during delivery. Authors reported that ultrasound is a useful tool to diagnose MAP, with 77%-93% sensitivity and 71%-98% specificity (12-16). Moodley et al. (17) concluded that the color flow Doppler was more specific, with a 95% negative predictive value (NPV) in the prenatal diagnosis of MAP, than magnetic resonance imaging (MRI), and MRI should be reserved for cases with inconclusive sonographic findings (13,15,17). The sonographic markers of placenta accreta can be seen in the first trimester of pregnancy in the form of low implantation of the pregnancy sac and multiple vascular spaces within the placenta (2). Prenatal diagnosis of MAP with gray-scale and Doppler sonography allows the development of the multidisciplinary team care approach during delivery (14). This current study aimed Objective: To detect the accuracy of the three-dimensional multislice view (3D MSV) Doppler in the diagnosis of morbid adherent placenta (MAP). Material and Methods:Fifty pregnant women at ≥28 weeks gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale ultrasound scan was performed for the subjects to confirm the gestational age, placental location, and findings suggestive of MAP, followed by the 3D power Doppler and then the 3D MSV Doppler to confirm the diagnosis of MAP. Intraoperative findings and histopathology results of removed uteri in cases managed by emergency hysterectomy were compared with preoperative sonographic findings to detect the accuracy of the 3D MSV Doppler in the diagnosis of MAP. Results:The 3D MSV Doppler increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 3D power Doppler. The sensitivity and negative predictive value (NPV) (79.6%...

Evaluation of Different Ultrasonographic Modalities in the Diagnosis of Morbidly Adherent Placenta: A Cross-Sectional Study

“…This suggested that if the retroplacental sonolucent area between the placenta and the uterus was preserved, morbidly adherent placenta was unlikely to occur with high NPV of 82%, 82.8% respectively.The current work showed that the presence of focal exophytic masses invading the urinary bladder had the highest PPV of 100%. This was in agreement with Moniem et al, 2015[16] but againstShih et al, 2009 [17] and Pilloni et al,2016 [18] studies which showed that thinning or disruption of hyperechoic serosa-bladder interface had the highest PPV of 100% and 77.8% respectively while irregular retroplacental sonolucent zone had the highest NPV of 82.8% and this was in accordance with Pilloni et al, 2016[18], but against Shih et al, 2009[17] and Moniem et al,2015…”

“…In the present study, for 2D-US, loss of retroplacental sonolucent zone has the [16] whose study showed that disruption of serosa-bladder interface had the highest NPV of 73% and 84.1% respectively.…”

Detecting Accuracy of Three Dimensional Power Doppler (3DPD) Vascular Indices for Prenatal Diagnosis of Morbidly Adherent Placenta in Patients with Placenta Previa

“…In Abdel Moniem et al [25] study on 50 pregnant patients with suspected MAP, using both 2D US and 3D Power Doppler scans to assess the best parameter that could predict MAP prenatally. The results show that the best 2D parameter was disruption of uterine serosal interface (81.8 sensitivity), so could be used in screening for MAP and the best parameter for confirmation of MAP diagnosis was presence of exophytic mass invading the bladder with 94.9% specificity.…”

Placental Chorioangioma Diagnosis and Management

“…Ultrasound is the most commonly used tool in the prenatal diagnosis of placental abnormalities, 13 and chorioangioma as well. Hypoechoic, well-circumscribed, ovoid or round intraplacental mass different from the rest of placenta containing small anechoic spaces that protruded into the amniotic cavity are the usual gray scale findings.…”