الفهرس 
Table of Contents
Chapter 1: Abnormal invasive placentationOnly 14 pages are availabe for public view
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Abstract
Placenta accreta represents one of the most morbid conditions in modern obstetrics, with high rates of hemorrhage, hysterectomy, and intensive care unit admission. Placenta accreta appears to be on the rise paralleling the rise in cesarean section rate as a major risk factor. Placenta accreta is the direct attachment of the placental trophoblast to the uterine myometrium, with no normal intervening decidua or basalis layer. Cases with partial or complete invasion of trophoblast through the uterine wall are called increta and percreta, respectively, though all three categories are collectively identified as “accreta”. Placenta increta and percreta have been diagnosed antepartum, and ultrasonographic findings may provide the only objective evidence of placenta accreta. A biochemical marker for this condition would therefore be useful. It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta. Several biological factors such as creatine kinase levels have been described in the past to reflect placental dysfunction, but these hypotheses have not been confirmed.The aim of our study was to indicate the possibility of using serum creatine kinase as a diagnostic and prognostic marker in placenta accreta.Forty five pregnant women in their second or third semester who were diagnosed with placenta accrete by documented ultrasound and Doppler were recruited and assessed for eligibility at the antenatal clinic and Inpatient department at Mansoura University hospitals. A control group was recruited including forty five pregnant participants with normal placenta.Both patients and control groups were subjected to full history taking, general examination and laboratory evaluation. We also obtained blood sample for examining the levels creatine kinase in sera of both patient and control group. Outcome of pregnancy both the primary and secondary were evaluated and documented.Our results indicated the presence of significant difference between the patient group and the control group regarding age (P-value= 0.01), gravidity (P-value= 0.01) and parity (P-value= 0.006). There was no significant difference between patient group and the control group regarding gestational age (P-value= 0.11) and number of fetuses from previous pregnancies (P-value= 0.59).Our results showed upon comparison of patient group to control group non-significant difference regarding history of miscarriage (P-value= 0.23), medical history (P-value= 0.59), surgical history (P-value= 0.51), history of Hysterotomy (P-value= 0.08), anteoartum haemorrhage (P-value= 0.65) and D & C (P-value= 0.82) and fetal viability (P-value= 0.15)On the other hand no significant difference was indicated between the patient and control group regarding serum creatine kinase level (P-value= 0.29). Regarding surgical outcome and intra-operative findings, we have identified eight surgical outcomes and intraoperative findings which occurred significantly in the patient group in compare with the control group (P value <0.001) including the presence of focal accretion, diffuse accretion, the incidences of bladder injury, CS hysterectomy alone, CS hysterectomy+ bladder injury, diffuse accretion+ PPH, diffuse accretion+ bladder injury and focal accretion+ bladder injury (P value<0.001).Our finding also revealed the presence of significant difference between the patient and control group regarding the number of required blood units transfusion (P value <0.001).