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Subject Area

Pediatric Surgery

Article Type

Original Study

Abstract

Objective The aim of this study was to assess the value of adding three-dimensional (3D) ultrasound (US) power Doppler vascular indices (as a diagnostic technique) to gray-scale technique for antenatal diagnosis of placenta accreta. Background Abnormal invasive placentation represents obstetric challenge that is associated with catastrophic hemorrhage. Varied terminologies have been applied to this condition; however, the recent guidelines suggested placenta accreta spectrum, which includes accreta, increta, and percreta. Patients and methods Evaluation of 100 pregnant patients with placenta previa was done. They had a mean age of 33.3 years. All patients were subjected to two-dimensional US and 3D power Doppler vascular indices US at gestational age between 28 and 34 weeks, before elective cesarean delivery. Results Of the 100 patients, 62 (62%) patients were proved to have abnormal placental invasion based on pathological outcome and 38 (38%) patients had conservative surgical management. The sensitivity of 3D power Doppler parameters was 96.6% for intraplacental hypervascularity, 88.7% for torturous vascularity and 88.7% for basal vessels involving bladder. Regarding the vascular indices, for vascularization index, sensitivity was 67.7%; for flow index, sensitivity was 48%; for vascular flow index, sensitivity was 87%; and for Virtual Organ Computer-aided Analysis (placental volume), sensitivity was 87%. In comparison, regarding the two-dimensional US parameters for diagnosis of placental invasion, for absence of sonolucent areas, sensitivity was 67.7%, for myometrial thickness less than 1 mm, sensitivity was 79%, for number of lacunae more than 4, sensitivity was 67.7%, and for presence of vascularity between placenta and cervix, sensitivity was 74%. Conclusion Combining 3D power Doppler to gray-scale and color Doppler US was more predictive of abnormal placental invasion.

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