الفهرس 
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Abstract
Caesarean section (CS) is an important lifesaving operation for both mother and child, and its use has increased dramatically over the last decade.
In women with placenta previa, the risk of placenta accreta varies from 2% in women younger than 35 years old with no previous caesarean section to 39% in women at or over 35 years of age with two or more caesarean sections. In the presence of these risk factors, the obstetrician must have a high index of suspicion for placenta accreta and take appropriate precautions. In particular, this condition must be included in the differential diagnosis in women with previous caesarean sections and anterior placentation.
The three forms of morbidly adherent placenta (MAP): placenta accreta, increta and percreta, represent a significant obstetric challenge, at times resulting in life-threatening bleeding, bladder injuries and/or peripartum hysterectomy. An accurate prenatal diagnosis is required to reduce the risk of maternal/fetal morbidity and mortality.
Morbidly adherent placenta can be diagnosed prenatally by different modalities although there is limitation of prenatal diagnosis as it is not histopathological diagnosis, but 2D ultrasound, 3D multi-slice Doppler, MRI have major role in prenatal diagnosis of morbidly adherent placenta.
This diagnostic test accuracy was conducted at department of obstetrics and gynecology at Maternity Hospital of Ain Shams University.
This study aimed to detect the accuracy of multi-slice 3D Doppler ultrasound in diagnosis of placenta accreta and degree of adherence in relation to postpartum histopathology and intrapartum findings.
Statistical analysis of the current study showed that multi-slice 3D Doppler ultrasound is more accurate than 2D ultrasound in diagnosis of placenta accrete and degree of adherence in relation to postpartum histopathology and intrapartum findings.
Regarding agreement between 2D and placental invasion, there was significant agreement to diffuse or focal lacunar flow and markedly dilated vessels over peripheral sub-placental zone; (p <0.001). On the other hand there was non-significant agreement between multi-slice 3D Doppler regarding numerous coherent vessels involving the whole uterine serosa–bladder junction and placental invasion; (p= 0.160).
Significant moderate agreement to loss of retro-placental sono-lucent zone, thinning or disruption of the hyperechoic serosa-bladder interface, focal exophytic mass invading the bladder, vascular lakes with turbulent flow; (p <0.001). On the same manner there was significant agreement between multi-slice 3D Doppler regarding disruption of serosa bladder interface) and placental invasion; (p <0.001).
Non-significant low agreement to irregular retro-placental sono-lucent zone, abnormal placental lacunar and hyper-vascularity of serosa–bladder interface; (p =0.077, 0.933 and <0.001) respectively. On the other hand there was significant low agreement between multi-slice 3D Doppler regarding abnormal placental lacunae and placental invasion; (p= 0.027).
Loss of retro-placental sono-lucent zone and hyper-vascularity of serosa bladder interface had the highest diagnostic characteristics among 2D ultrasonography signs in the diagnosis of placental invasion with sensitivity and specificity 90.5%, 69.0% and 90.5%, 89.7% respectively. On the other hand crowded vessels over peripheral sub-placental zone had the highest diagnostic characteristics among multi-slice 3D Doppler signs in the diagnosis of placental invasion with sensitivity and specificity 95.2% and 93.1%.