الفهرس 
THE NORMAL PLACENTAOnly 14 pages are availabe for public view
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Abstract
SUMMARY
The incidence of morbidly adherent placenta has increased dramatically over the last three decades, in concern with the increase in the caesarean section rate.
Abnormal placentation into the uterine wall could present a risk of maternal and fetal morbidity, if placental delivery fails, it can result in severe postpartum hemorrhage with possible multiple organ failure and damage to the nearby organs such as bladder and bowel.
Prenatal ultrasonography (US) represents the first-line method for diagnosing antepartum placental abnormalities. Ultrasound is a safe, extremely effective and essential for providing optimal prenatal screening. In the past two-dimensional ultrasound was used alone, nowadays three-dimensional (3D) ultrasound appeared to be more specific, sensitive and accurate.
In our study we included 185 patients diagnosed as adherent placenta by standard 2D ultrasound examination from the special care unit of fetus Ain Shams maternity hospital.
All our patients were assessed by transvaginal two-dimensional ultrasound then by transabdominal three-dimensional ultrasound using Samsung WS80A with elite ultrasound in order to fulfill RCOG criteria of diagnosing MAP.
The patients were seen at the time of delivery to compare the sonographic findings with the intraoperative results.
Our results showed that CS section was a significant risk factor for morbidly adherent placenta (P value < 0.001). In addition, repeated cesarean section increases the degree of accretion (P value < 0.001). Placenta percreta was highest among patients with previous three or more cesarean sections.
Regarding suspected complications, out of 185 cases, 27 cases (14.6%) had hysterectomy while 17 cases (9.2%) had visceral injury. ICU and NICU admision were needed in 13.5 % (25 cases) and 38.3 % (71 cases) of patients respectively, otherwise blood transfusion was done for 38 cases (20.5 %) only of all included patients.
Our results showed that 3D ultrasound had higher diagnostic characteristics in differentiating different types of MAP in comparison to 2D US as well as diagnostic accuracy of 3D ultrasound was higher 96.8% versus 88.6% of 2D ultrasound, sensitivity 97.8% versus 86.7%, specificity was 96.4% versus 89.3%, PPV 89.8% versus 72.2%, and NPV 99.3% versus 95.4%.
And hence our study, In line with most recent studies, Emphasizes the significance of 3D ultrasound - preferably with Crystal Vue® software – for more accurate diagnosis of MAP and its types, which will hopefully cause a vital decrease in complications as well as a hoped apparent decline in maternal morbidity and mortality ratios.
CONCLUSION
• The results of this study showed that 3D ultrasound has higher diagnostic accuracy compared to 2D ultrasound, in terms of sensitivity, specificity, PPV and NPV.
• Since 3D ultrasound is easily available nowadays, safe and non invasive, it would appear more sensible to suggest that all pregnant women above 28 weeks gestation who were screened during second trimester, diagnosed as placenta previa by standard 2D ultrasound examination should be assessed by 3D ultrasound in order to decrease incidence of suspected complications.
RECOMMENDATIONS
Based on the results of the present study, it is recommended to perform 3D ultrasound examination, preferably with Crystal Vue® software, from 28 weeks of gestation to follow up all patients with MAP who were diagnosed by 2D ultrasound at 2nd trimester to enhance preoperative diagnoses of MAP & its different subtypes, and hence, reduce perioperative morbidities and mortalities from MAP.