الفهرس 
PATHOPHYSIOLOGY OF MORBIDLY ADHERENT PLACENTAOnly 14 pages are availabe for public view
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Abstract
Background: Morbidly adherent placentation (MAP) is a condition in which the placenta is abnormally attached to the uterine myometrium. Ultrasonography remains the primary diagnostic tool for MAP, with magnetic resonance imaging (MRI) serving as a secondary diagnostic modality. Aim of the Work: to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa. Patients and Methods: This prospective cohort study was conducted on 50 women having pregnancies complicated with placenta previa (from 32 weeks gestational age with anterior placenta previa with previous cesarean section and were planned for elective cesarean section at the department of Obstetrics and Gynecology, Ain Shams University Maternity Hospital in the period from September 2018 to September 2019. Results: Placental invasion was in more than one third of the studied cases by ultrasound, elastography, intraoperative histopathology (36%, 34%, 38% respectively). Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. Hemostatic sutures were used in 66 %, severe bleeding was observed in 34 % of cases blood transfusion was administered in 40 % of cases, whereas hysterectomy was performed in 24 % of recruited cases from those cases histopathology showed invasion in 9 cases (75 %) and no invasion in 3 cases (25%). There was a statistically significant high agreement between placental invasion diagnoses by US and elastography (p value<0.001); however there are 2 cas¬es that had no sonographic evidence of invasion but have demonstrated elastographic evidence of invasion with proven intraoperative focal invasion. There was statistically significant moderate agreement between placental invasion (by intraoperative diagnosis) and elastography (p value<0.001), true positive =28%, true negative =56%, false positive=6%, false negative =10%. Our results showed that Doppler had highest diagnostic characteristics with sensitivity 94.7% specificity 96.8%, followed by combined (Doppler, US, elstrography) with sensitivity 100% and specificity 87.1% then US with sensitivity 89.3% with sensitivity 89.5%, specificity 96.8% and least is elastrgraphy with specificity 90.3% and specificity 73.7%. Conclusion: For this study we have conclude that elastography has no superiorily in diagnosis of placental invasion above ultrasound, but it may be useful in diagnosis of focal invasion.