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

Abstract

Morbidly adherent placenta is asignificant cause of maternal morbidity , mortality and massive obstetric hemorrhage. It is defined as an abnormal placental adherence either in whole or in part of the placenta to the underlying uterine wall. It is a potentially life threatening condition responsible for 7-10% of maternal mortality.Is to evaluate the accuracy of Color Doppler Ultrasonography in antenatal diagnosis of placenta previa accreta in patients with previous cesarean sections. The study included 60 pregnant females after 28 week of gestation from obstetrics and gynecology department of Banha University hospital during a period from (1 st of December 2018 to 30 th November 2019) with suspected history and ultrasonographic findings of placenta accreta. Gray-scale B-mode transabdominal sonography and Color Doppler Ultrasound scans were done. The overall accuracy of diffuse or focal lacunar flow was 73.3%, vascular lakes with turbulent flow 70%, Hypervascularity of serosa bladder interface 62% and markedly dilated vessel over peripheral sub-placental zone 71% in doppler ultrasound. Color Doppler does not appear to improve the accuracy of Gray-Scale so, it is suggested to use both Gray scale ultrasound and Color Doppler in all cases of placenta previa with previous C.S to find out features that suggest presence of placenta accreta.

The Role of Colour Duplex in Antenatal Assessment of Placental Adhesive Disorders in Patients with Previous Cesarean Scar

“…These hypoechoic areas were demonstrated to be vessels moving perpendicular to the line through the myometrium on Doppler examination [10] . Saad et al, [9] illustrated that there were 32 cases diagnosed accreta according to color doppler and 24 cases were diagnosed accretaintraoperatively with significant difference (p-value=0.001) [9] .…”

“…85 So Our study reveals that the most sensitive ultrasound feature for placenta accrete is presence of irregular retroplacental sonolucent zone together with presence of abnormal placental lacunae by colored duplex although there is no more specific ultrasound finding for accrete, these two sensitive finding are in going with accrete diagnosis unless there is no presence of exophytic mass lesion nor thinning or disruption of the hyperechoic serosal layer to distinguish this accrete type from percreta and increta respectively. Saad et al, [9] documented that sensitivity, specificity, PPV and NPV of Doppler US were 88.2%, 75%, 69.8%, 87% respectively for placenta accreta diagnosis. Nawab et al, [12] reported that a prospective consider starting with pakistan news person that the sensitivity, specificity, PPV, NPV, ultrasonic were 85.7%, 83.3%, 66.7%, 93.8% and 84% separately.…”

“…3-Hypervascularity of serosa-bladder interface. 4-Markedly dilated vessels over peripheral subplacental zone [9] . 5-The imaging played careful attention to: The echogenic patterns of the placenta, absence of normal subplacental various complex placental sonolucent lakes and/or irregularities of bladder uterine serosa was noted.…”