Prevalence and diagnostic accuracy of Doppler ultrasound of placenta accreta in Egypt

Abstract Objective: The objective of this study is to assess the prevalence of placenta accrete (PA) among those with placenta implanted over cesarean section (CS) scar and to evaluate the accuracy of Doppler ultrasound in diagnosis. Methods: A cross-sectional study included 100 patients with placenta previa (PP) anterior with at least one previous CS. Ultrasound and color Doppler were done to all participants and correlated with operative findings. Results: There was a significant difference between accrete and non-accrete group regarding maternal age (32.6 ± 5.01 versus 29.14 ± 4.89), and a highly significant difference regarding the postoperative hemoglobin (6.71 ± 1.156 versus 8.41 ± 1.257) and the number of previous CSs (p <.001). The abnormal Doppler findings showed a highly significant difference between the two groups as loss of retroplacental clear zone (87.3% versus 10.8%), intraplacental lacunae (93.7% versus 37.8%), hypervascularity in uterine bladder interface (47.6% versus 5.4%), and blood vessels invading myometrium (82.5% versus 18.9%) (p < .001). The sensitivity, specificity, PPV, NPV, and accuracy of loss of retroplacental clear were 87.3%, 89.19%, 93.2%, 80.49%, and 88%; intraplacental lacunae were 93.65%, 62.16%, 80.82%, 85.19%, and 82%; hypervascularity in uterine bladder interface were 47.62%, 94.59%, 93.75%, 51.47%, and 65%; dilated vessels over peripheral subplacental zone were 82.54%, 81.08%, 88.14%, 73.17%, and 82%, respectively. There was a highly significant difference between the two groups regarding surgical management with cesarean hysterectomy, occurrence of bladder injury, the need for intraoperative, and postoperative blood transfusion, ICU admission (p < .001). Conclusion: The use of ultrasound together with the color Doppler allowed for better prediction of placental invasion of the myometrium prior to obstetrical intervention to improve the maternal and the fetal outcome.

[1]  N. Budorick,et al.  Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta , 2017, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[2]  D. Jurkovic,et al.  Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. , 2016, American journal of obstetrics and gynecology.

[3]  A. Maged,et al.  Third‐trimester uterine artery Doppler measurement and maternal postpartum outcome among patients with severe pre‐eclampsia , 2015, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[4]  A. Abdelaziz,et al.  Diagnostic accuracy of ultrasound and MRI in the prenatal diagnosis of placenta accreta , 2013, Acta obstetricia et gynecologica Scandinavica.

[5]  Jason D. Wright,et al.  Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta , 2013, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[6]  G. Puccio,et al.  Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta , 2013, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[7]  F. Chantraine,et al.  Prenatal diagnosis of abnormally invasive placenta reduces maternal peripartum hemorrhage and morbidity , 2013, Acta obstetricia et gynecologica Scandinavica.

[8]  R. Silver,et al.  Maternal Morbidity in Cases of Placenta Accreta Managed by a Multidisciplinary Care Team Compared With Standard Obstetric Care , 2011, Obstetrics and gynecology.

[9]  C. Crum,et al.  Pathophysiology of placenta creta: the role of decidua and extravillous trophoblast. , 2008, Placenta.

[10]  P. Stone,et al.  Suggested Approach for Management of Placenta Percreta Invading the Urinary Bladder , 2007, Obstetrics and gynecology.

[11]  N. Papantoniou,et al.  Emergency obstetric hysterectomy , 2007, Acta obstetricia et gynecologica Scandinavica.

[12]  B. Sibai,et al.  Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries , 2006, Obstetrics and gynecology.

[13]  J. Smulian,et al.  Placenta Previa, Placenta Accreta, and Vasa Previa , 2006, Obstetrics and gynecology.

[14]  C. Comstock,et al.  Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. , 2004, American journal of obstetrics and gynecology.

[15]  D. Twickler,et al.  Color flow mapping for myometrial invasion in women with a prior cesarean delivery. , 2000, The Journal of maternal-fetal medicine.

[16]  S. Clark,et al.  Placenta Previa/Accreta and Prior Cesarean Section , 1985, Obstetrics and gynecology.

[17]  P. Flood,et al.  Cesarean hysterectomy requiring emergent thoracotomy: a case report of a complication of placenta percreta requiring a multidisciplinary effort. , 2012, The Journal of reproductive medicine.

[18]  T. Rutherford,et al.  105: Decreased expression of endostatin (ES) and hypoxia-inducible factor 1⍺ (HIF-1⍺) is associated with excessive trophoblast invasion and aberrant angiogenesis in placenta accreta , 2012 .

[19]  T. Freilich Obstetrical hemorrhage. , 1974, The Journal of the American Osteopathic Association.