The Role of Colour Duplex in Antenatal Assessment of Placental Adhesive Disorders in Patients with Previous Cesarean Scar

Document Type : Original Article


The Department of Radiodiagnosis*, Faculty of Medicine, Ain Shams University and Gyncology & Obstetric Department**, at Dessouq Hospital, Kafhr El Sheikh Government and Ain Shams University


Abstract Background: Although relatively rare, placental adhesive disorders account for a large percentage of maternal morbidity and mortality in modern obstetrics. Hemorrhage is a major complication of abnormal placentation, and early diagnosis and intervention in these conditions can more readily enable the physician to minimize the risks to mother and fetus. The current widespread use of ultrasound in obstetrics has greatly advanced our ability to diagnose and manage abnormal ob-stetric bleeding. Aim of Study: To test the role of gray scale and color Doppler in antenatal assessment of placental adhesive disorders in patients with previous cesarean scar and comparing data with operating room finding. Patients and Methods: This was cross sectional study, was carried out in Radiology department, Gyncology and Obstetric Hospital at Ain Shams University, Gyncology and Obstetric Department at Dessouq hospital, Kafhr El Sheikh government, Egypt, on 26 pregnant women with placenta previa and previous cesarian scar during a period of 6 months. Results: Twenty six pregnant females with previous history of CS were included. Ultrasound has an overall good diagnostic role in identifying each type of placental adhesive disorders as according to US findings for prediction of placental disorders from others, there were 14 of the studied sample had P. Accreta as 85.71% with Sensitivity, 100.00% with Specificity, There were 9 of the studied sample had P. Increta as 88.89% Sensi-tivity, 100.00% with Specificity. There were 3 of the studied sample had P. Percreta as 100.00% Sensitivity, 100.00% with Specificity, 100.00% with PPV, and 100.00% with NP. Com-pared to the operating room there were 14 (53.8%) of the studied cases had Accreta, 3 (11.5%) had Percreta and 9 (34.6%) had Increta. Conclusion: US remains the primary screening modality of antenatal assessment of placental adhesive disorders or what is called Placenta Acrreta Spectrum disorders (PAS). 2D Gray scale has higher sensitivity than color Doppler in diagnosis of placental adhesive disorders. The presence of Irregular retro-placental sono lucent zone had the highest sensitivity for detection of PAS.