Color Doppler ultrasound in diagnosis of placenta accreta

Abstract

Background: Placenta accreta is a major source of maternal morbidity and mortality and is currently the major reason for peripartum hysterectomy. The strict etiology is indefinite, but it has been postulated to be correlated to the injury of the decidua basalis, which allows for the placental attack into the myometrium. Purpose: To evaluate the accuracy of color Doppler ultrasonography in the diagnosis of placenta accreta and to compare it with the diagnostic accuracy of both 2D Ultrasonography and MRI. Material and Methods: A prospective study was done at Obstetrics and Gynecology Department of Tanta University Hospital, Egypt. The study included 100 patients with suspected placenta accreta based on 2D ultrasonography, color Doppler and MRI. The intraoperative findings of each case were compared with the preoperative imaging findings. Results: Sensitivity for the diagnosis of placenta accreta was (100%) for color Doppler ultrasound, (93.7%) for 2D ultrasound and (75 %) for MRI. Specificity was (66.6 %) with color Doppler and (77.7%) for 2D ultrasound and (55.5%) for MRI. The highest positive predictive value (PPV) was found in 2-D ultrasound (88%), MRI had the lowest PPV (75%), while color Doppler had 84%PPV. Negative predictive value (NPV) was (100%), (87.5%), (55.5%) for color Doppler, 2D ultrasound and MRI, respectively. Conclusion: Color Doppler Ultrasound is the most accurate imaging modality in the diagnosis of placenta accreta. Its accuracy, when combined with 2D ultrasound, would increase and provides the best available modality for diagnosis of placenta accreta.

Sonographic Detection of Placenta Accreta in The Second and third Trimesters of Pregnancy

“…In agreement with our findings, the study of Borg et al, 11 reported that intraoperatively (64 %) of patients were PA while, (36 %) of them were non-PA.…”

“…In comparison with the study of Borg et al, 11 concluded that sensitivity for the PA diagnosing was (100 %) for CDUS, (93. Warshak et al, 24 concluded that US had sensitivity (77%) and specificity (96%).…”

“…PA is a main cause of mother morbidities and mortalities and is presently the main cause for peripartum hysterectomy. 11 The exact reason isn't definite, but it was assumed to be connected to the injuries of the decidua basalis, which permits for the placenta attacks into the myometrium. The wall function of the decidua is lost in these conditions, and the invasive trophoblasts can enter the myometrium to changing lowest point, from the shallowest PA to deeper myometrial attack PA, with breaches of the uterine serous membrane and can assault adjacent organs.…”

Role of Color Doppler Ultrasound in Antenatal Diagnosis of Placenta Accreta in Patients with Previous Cesarean Scar

“…Overall, in [13] study, the analysis for abnormal connection of the placenta of the myometrium might have been right to (100%) from claiming cases to doppler ultrasonography. Those affectability for the finding about placenta accreta might have been (100%) for color doppler ultrasound, Furthermore (93.…”

Accuracy of three-dimensional multislice view Doppler in diagnosis of placenta accreta spectrum

“…Thus, proper antenatal diagnosis enabeling proper preparation and timing of intervention, is crucial in the management of PAS. Second and third trimester 2D gray scale ultrasound has been used for long as the main diag-nostic tool for PAS mainly due to its availability, 2D Doppler have been used also in conjunction though has not proved to increase the diagnostic accuracy substantially [14]. Several signs were suggested and studied for the diagnosis of PAS with variable degrees of sensitivity and specificity, the most widely accepted are the loss or irregularity of the retro placental sonolucent zone, thinning or disruption of hyperechoic serosa-bladder interface, presence of focal exophytic masses invading the urinary bladder, and presence of abnormal pla-cental lacunae [9].…”