الفهرس 
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Abstract
The term morbidly adherent placenta describes aberrant
placentation characterized by abnormally implanted, invasive, or
adhered placenta. We also refer to these disorders collectively as
accrete syndromes.
Ideally, sonography is used for antepartum identification of
abnormal placental ingrowth, ultrasound imaging is highly accurate
when performed by a skilled operator with experience in diagnosing
placenta accreta spectrum.
First-trimester measurement of the smallest myometrial
thickness can be used to predict the necessity for peripartum
hysterectomy with an accrete syndrome. Other findings include loss of
the normal hypoechoic retroplacental zone between the placenta and
uterus, placental vascular lacunae, and placental bulging into the
posterior bladder wall. Better results have been reported by some
using three-dimensional (3-D) sonography and power Doppler.
The aim of this study was to assess the value of adding 3D
power Doppler (as a diagnostic technique) to gray scale technique in
the antenatal diagnosis of morbidly adherent placenta as well as
predicting the surgical outcome regarding the intra operative
morbidities. If proven of value this might help in Reducing maternal
morbidity and mortality through Confirmation of diagnosis of MAP
and preoperative assessment of surgical risk and proper preparation of
the patient for surgery.
For each patient, we implemented the following: 1) antenatal
diagnosis, 2) pre-operative preparation, 3) planning the surgical
technique, 4) post-operative care, 5) assessment of the morbidities,
and 6) counseling and an informed written consent.
The present study‟s results on the sensitivity of the Sonographic
criteria can be summarized as follows.
As regard the accuracy of 2D ultrasound parameter for
diagnosis of placenta accreta, absence of Sonulcent areas, sensitivity
was 67.7%, specificity 73.6, PPV80.7% and NPV 58.3%,Myometrial
thickness less than 1mm, sensitivity was 79%, specificity 60, PPV
77.7% and NPV 63.8%,number of lacunae more than 4 sensitivity
67.7%, specificity 77.7, PPV 56.5% and NPV 66% and presence of
vascularity between placenta and cervix sensitivity was 74%,
specificity 81.5, PPV 86.7% and NPV65.9%.
As regard the accuracy of 3D ultrasound parameter for
prediction of placenta accreta, Intraplacental hyper vascularity
sensitivity was 96.6%, specificity was 81%, PPV was 89% and NPV
was 93%, Torturous vascularity sensitivity was 88.7%, specificity
was78.9%, PPV was 87% and NPV was 81% and basal vessels
involving bladder sensitivity was 88.7%, specificity was 78.9%, PPV
was 87.3% and NPV was 81%. As regard vascular indices, VI
sensitivity was 67.7%, specificity was 89%, PPV was91% and NPV
was 93%, FI sensitivity was 48%, specificity was 77.7%, PPV was
93% and NPV was 65%, VFI sensitivity was 87%, specificity
was76.9%, PPV was 85% and NPV was 78% and VOCAL (placental
volume) sensitivity was 87%, specificity was 76.9%, PPV was 85%
and NPV was 78%.
As regard the pathological finding of the spacement after
hysterectomy, 28 (47%) of cases were accreta, 21(33%) were increta
and 13(20%) were percreta.
Regarding the surgical outcomes, the study found that the
average blood loss was 2072.81± 653.48 ml. The organ injury that occurred was bladder injury occurred in 19 case and only one case
ureteric injury. The number of packed RBC was 5.23±2.21 units
The accuracy of ultrasound in predicting placental invasion and
surgical risk, we found very promising results when we compared the
antenatal Sonographic criteria with pathological and various surgical
outcomes. There was a statistically significant greater risk of placental
invasion and intraoperative blood loss and greater number of units of
blood and packed RBC transfusion in presence of certain criteria.
These criteria were: the absence of sonolucent area, the greater length
of vascularization, thin myometrial thickness, presence of more than 4
vascular lacunae, greater number of bridging vessels, and the presence
of any of the 3D power Doppler criteria except FI parameter. On the
other hand, vascular lacunae and cervical length didn‟t seem to have
any impact on the surgical outcome and its severity.