الفهرس 
Chapter (I): Morbid Placental AdherenceOnly 14 pages are availabe for public view
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Abstract
Morbidly adherent placenta can be diagnosed prenatally by different
modalities although there is limitation of prenatal diagnosis as it is not
histopathological diagnosis, but 2D ultrasound, 3D multislice Doppler, MRI
have major role in prenatal diagnosis of morbidly adherent placenta. In women
with placenta previa, the risk of placenta accreta varies from 2% in women
younger than 35 years old with no previous caesarean section to 39% in women
at or over 35 years of age with two or more caesarean sections.
Morbidly adherent placenta is a potentially life-threatening condition and
if unsuspected can lead to catastrophic postpartum hemorrhage, disseminated
intravascular coagulopathy, renal failure, acute respiratory failure and maternal
mortality, prenatal diagnosis is of paramount importance as it helps in
preoperative planning, decreasing potentially fatal complications.
3D multislice Doppler is a fast-evolving imaging technique that holds a
great potential for use in obstetrics and gynecology. Its sensitivity and
specificity are reported to be close to 100% for diagnosing congenital uterine
anomalies comparable with those of MRI & laparoscopy, it can also be used for
defining and mapping uterine lesions such as fibroids, adenomyosis, intrauterine
synechia and initial evaluation of malignancy suspected patients, it can also be
used in evaluation of artifacts in fetal heart scanning during second trimester.
So, the aim of this study was to Evaluation of the Role of the multislice 3D
Doppler in the diagnosis of Morbid adheret placenta in relation to intrapartum
findings and the mean value of placenta volume vascularization index and flow
index and vascularization flow index.
To elucidate our aim, a prospective study that was conducted at Menoufia
University Hospitals, after approval from faculty of medicine ethics committee
for human research (IRB approval number: 11/2021OBSGN-29). All enrolled
women provided an informed consent of volunteer for participation in the study.
Summary
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aim and steps of the study were explained to each participated patient before the
consent.
Study Intervention: Examination: General condition, Height, Weight, Pulse,
Blood pressure Local examination. Abdominal examination: Inspection:
Size, Shape, striae, veins, scars, movement with respiration, pigmentations,
hernia orifices. Palpation: Fundal level, symphysiofundal height, Fundal grip:
Cephalic or breech Empty. Transverse, Umbilical grip:(For Lie, back and limbs,
amount of liquor, expected fetal weight, for any local uterine swellings) 1 st
and 2nd pelvic grip (Pawlick s grip): To determine: presenting part and Head
engagement.
Investigations: Laboratory: CBC, RH, Blood group and blood sugar, urine for:
glucose, protein and bacteria, kidney function tests, Liver functions tests.
Ultrasound: All participated women had been examined by 2D ultrasound
showing low lie placenta or placenta previa to be included in the study.
The results of this study could be summarized as follows:
Placental vol vascularization index and vascularization flow index were
significantly increased among type 3 (61.73±16.41, 22.83±4.96) than type 2
(57.73±24.46, 20.11±7.68) and type 1 (43.14±17.54, 15.49±6.47)
respectively (P=0.010, 0.003).
There was significant relation between type 1 with type 3 regarding
Placental vol vascularization index 3D and Placental vol vascularization
flow index 3D (P=0.003, 0.001) respectively.
While, placental vol vascularization index 3D and Placental vol
vascularization flow index 3D didn’t show any significant relation between
type 1 with type 2 (P=0.141, 0.168) and type 2 with 3 (P=0.687, 0.419)
respectively.
There was significant difference among the studied groups regarding loss of
Sonolucency, and abnormal uterine serosa bladder line (P<0.001).
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Loss of Sonolucency was found in 1 (5.0%) of women of type1, 4 (100%)
of women of type 2 and 16 (94.1%) of type 3.
Also, abnormal uterine serosa bladder line was found in 1 (5.0%) of women
of type1, 4 (100%) of women of type 2 and 12 (70.4%) of type 3.
There was no significant difference among the studied groups regarding
Irregular placental lacunae (P=0.231).
There was significant difference among the studied groups regarding blood
loss less than 2000 CC, blood loss more than2000cc, vesicouterine plane
and vesicouterine neovascularization (P<0.001).
Blood loss less than2000CC was found in 15 (75.0%) of women of type 1
and 3 (17.6%) of type 3.
Blood loss more than2000cc was found in 5 (25.0%) of women of type 1, 4
(100.0%) of women of type 2 and 14 (82.4%) of type 3.
Vesicouterine plane was found in 19 (95.0%) of women of type 1 and 1
(25.0%) women of type 2.
Vesicouterine neovascularization was found in 2 (50.0%) of women of type
2 and 16 (94.1%) women of type 3.
On the other hand, there was no significant difference among the studied
groups regarding thin anterior uterine segment and placenta reach serous
surface (P>0.05).
There was significant difference among the studied groups regarding
placenta separation, focal accretion, preserve uterus and CS hysterectomy
(P<0.001).
Placenta separation was found in 19 (95.0%) of women of type1, 1 (25.0%)
of women of type 2.
Focal accretion was found in 3 (75%) of women of type 2 and 2 (11.8%) of
type 3.
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Uterus preservation was found in 19 (95.0%) of women of type1, 3 (75.0%)
of women of type 2.
CS Hysterectomy was found in 16 (94.0%) of women of type 3.