الفهرس 
AbstractOnly 14 pages are availabe for public view
 |  | from | 113 |  |  |
| | | from | 113 | | |
Abstract
Placenta previa refers to the presence of placental tissue that extends over the internal cervical os.
Placenta accreta spectrum ( PAS ) is the general term applied to abnormal adherence of the placental trophoblast to the uterine myometrium; it is also referred to as morbidly adherent placenta. the pooled prevalence of placenta previa is about 4 per 1000 births , PAS incidence approximately 1 in 1000 to 2000 pregnancies.
The major causes of PAS include placenta previa (placenta that partially or completely covers the cervical os) and previous cesarean delivery; the risk is greater when both factors are present and when the previa overlies the scar. The greater the number of previous cesarean deliveries, the higher the risk.
Prenatal screening and diagnosis are important so that the patient and her family can be counseled about the suspected placental abnormality and an appropriate site and plan for delivery can be developed.
Prenatal diagnosis of MAP is done mainly by imaging by US.
This study was carried out on 60 patients attending the obstetrics outpatient clinic of Beni-Suef University Hospital where 60 pregnant women with at least one 1st trimester ultrasound criteria suggesting PAS were enrolled into this study
Detailed medical history was taken from each patient followed by full general and local examination; accordingly patients were included or excluded from the study.
Patients Included in this study were
a- Pregnant women with history of uterine scar as cesarean section and myomectomy
b- 1st trimester ultrasound show at least one of the following :
1- Low implantation of the gestational sac, defined as a gestational sac implanted in the lower third of the uterus between 8 and 10 weeks or primarily occupying the lower uterine segment .
2- low-lying placenta, defined as the edge reaching to or within 2 cm from the internal cervical os in the cases of anterior placenta and reaching or covering the internal cervical os in the cases of posterior placenta , both with or without thin myometrium and/or bridging vessels.
3- Presence of anechoic areas within the placenta with or without doppler flow demonstrated.
4- Irregular placental‐myometrial interface .
Patients with this criteria was excluded a-Unscarred uterus
b-If patient included aborted before 24 weeks GA
For each patient included in the study, the whole placenta was scanned in a systematic fashion using both gray-scale ultrasound and color flow mapping.
Reexamination of placenta was done by ultrasound later in 3rd trimester to see if it was persistent placenta previa with signs of accreta
All the pregnancies enrolled in this study was delivered by cesarean section at our hospital with full availability of information on the delivery.
The mean age of the patients is 30 ± 4.7 years. The range of age (20-40 yrs.). The mean gravidity is 4.2±1.2; range (2-8), parity 2.9 ±1.1.1; range (1-6) and the number of previous Cesarean section 2.6 ±1.2; range (1-6). The mean timing of delivery was at 37.3 ± 1.11 weeks.
Among 60 patients, the majority of cases (56.7%) presented with low GS and placenta low anteriorly. Lacuna and loss of interface were present in 45% of cases, third-trimester signs of accreta were present in 66.7% of cases
Among the studied cases, 53.3% showed morbid adherence to the placenta, and about 48% underwent a hysterectomy, 60% complained of postpartum hemorrhage, 60% required blood transfusion, and a few percent 11% required pelvic devascularization. A percent of 16 % complicated with bladder injury .
About 13.3% of the new births required NICU admission, 28.3% of the mothers required ICU admission. There was no maternal deaths .
Older age, higher gravidity, higher parity, and higher number of previous sections were significantly associated with morbid adherence of the placenta. P-value was (0.016, 0.001, 0.003 and 0.001 respectively) .
All studied U/S findings were significantly associated with the presence of morbid adherence; P-value was less than 0.005 except for placenta low lying posteriorly was significantly associated with negative morbid adherence and p-value was
0.001 .