الفهرس 
OVERVIEW OF PLACENTAOnly 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
Placenta accreta spectrum is one of the most dangerous conditions associated with pregnancy, because hemorrhage may result in multisystem organ failure, disseminated intravascular coagulation, need for admission to an intensive care unit, hysterectomy, and even death.
PAS is linked to placenta previa, and there is a lot of overlap in imaging findings between the two processes. PAS problems affect approximately 11% of people with placenta previa. Differentiating between placenta previa with and without PAS problems is crucial in clinical practice. A finding of placenta previa together with a history of cesarean delivery has long been an indication for counseling patients on their risk of PAS in a current pregnancy, as the risk for placenta accreta in the presence of placenta previa increases with each subsequent cesarean delivery
Prenatal diagnosis of AIP has been shown to reduce maternal morbidity associated with this condition, most likely due to the opportunity to plan management in advance. Ultrasound is the primary investigation for prenatal diagnosis of morbidly adherent placenta, and the diagnostic accuracy is good both in retrospective, as well as prospective case series
Current prenatal diagnosis of PAS disorders relies on subjective individual interpretations of visual sonographic findings on grayscale and color Doppler imaging. While multiple signs have been reported in the literature, even experts provide a range of different descriptions, and efforts are currently underway to provide uniform lexicon and descriptors.
Our prospective study evaluated placental thickness in the lower uterine segment in patients with placenta previa and whether increased placental thickness has direct correlation with the development of PAS. Intraoperative attendance of cesarean section was ensured; cases with spontaneous complete placental separation were recorded along with histopathological confirmation of PAS in cases that underwent cesarean hysterectomy or conservative surgery in the form of myometrial resection
The study included 40 pregnant patients with ultrasound proven diagnosis of placenta previa or low lying placenta; 20 patients (50%) were diagnosed with PAS which was confirmed by histopathology while 20 patients (50%) didn’t have PAS and their placenta were separated completely at CS. 85% of patients with PAS (17/20) underwent cesarean hysterectomy which is the standard treatment for morbidly adherent placenta while the remaining 15% (3/20) had focal invasion and underwent conservative surgery in the form of myometrial resection.
The study showed direct correlation between age, parity and number of previous cesarean deliveries with the development of PAS while increased BMI had no association with PAS development.
Maximum placental thickness in the lower uterine segment was significantly higher in PAS patients. ROC curve analysis showed that placental thickness of 58mm was associated with 55 % sensitivity, 90 % specificity, 84.6% PPV and 66.7% NPV for development of PAS. Such finding can be implemented into clinical practice by using placental thickness as a screening test for PAS in patients with placenta previa and previous cesarean delivery.
There was no significant difference between patients with PAS and patients with no PAS regarding preoperative hemoglobin while the number of transfused units of packed RBCs intraoperatively was significantly higher in PAS patients. Moreover, the incidence of bladder injury was not significantly higher in the PAS group
Having more than three previous cesarean deliveries and placental thickness more than 58mm were independent risk factors for PAS in our study.