الفهرس 
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Abstract
Placenta previa (PP) is a pregnancy complication where placenta partially or completely covers the internal cervical os after 20 weeks. It was found to complicate approximately 0.3-0.8% of all pregnancies world wide, (Tuzovic et al, 2003).
Pathological implantation of the placenta (placenta accreta) complicates 7-10% of cases of placenta previa, (Hasegawa et al ,2009).it ranges from its mildest degree where the chorionic villi just in contact with the myometrium (placenta accrete) ,to the more invasive type ,(increta) and (percreta) where the chorionic villi invades partially into the endometrium or totally to penetrate through the serosa respectively, (Heller et al ,2013), (Tan et al, 2007).
Potential risk factors contributing to the deelopment of PP are, Multiparty, advanced maternal age, cigarette smoking, previous cesarean delivery, history of abortions or uterine surgical procedures, cocaine use, and PP in a previous pregnancy, sub mucous myoma, previous curettage, and Asherman’s syndrome,( Sivan et al, 2010).
There are several methods for diagnosis of PP; transvaginal ultrasound seems to be the easiest diagnostic tool to establish the diagnosis, (Ilan et al, 2012).
The risk of developing placenta accretes increases with the number of previous cesarean deliveries. These range from 2% among women with a placenta previa only to 39–60% among women with accompanied two or more prior cesarean deliveries,
(Sivan et al, 2010).
During the third trimester, measurement of the distance from the placental edge to the internal cervical os is used commonly to gauge the likelihood of the need for cesarean delivery. There is consensus that a placenta previa that totally or partially overlies the internal os requires delivery by cesarean section. More controversial is the optimal mode of delivery when the placenta lies in proximity of the internal os. Three studies concluded that a placental edge to cervical os distance of _20 mm permits a safe vaginal delivery, (Oppenheimer et al ,2003).
It is generally accepted that placenta accreta is ideally treated by total abdominal hysterectomy, in addition, there is almost universal consensus that the placenta should be left in place; attempts to detach the placenta frequently result in massive hemorrhage, however, the physician should be aware that focal placenta accreta may exist that may not require such aggressive therapy, (Oyelese et al, 2006).
This work aim To study the prevalence of placenta previa in our locality , to do a comparison between placenta previa in scared and non scared uteri , to know the effect of scar on placenta previa, as regard prevalence , degree , myometrial invasion, management, and effect on maternal and fetal outcome.
The current study carried out at sohag university , from January 2014 till june 2015
The study included all pregnant women beyond 20 week gestation , that registered and delivered at sohag university hospitals.
At retrospective part , files of patient were examined for the following data : past and present history, Fetal and maternal out come .
In prospective part , good history was taken from patient , routine investigations and TVS were done for all patients were followed up till time of delivery , fetal and maternal outcome was included.
The patients are divide in two group : (scared and non scared ) and comparison between the two groups as regard pravelance , degree, myometrial invasion , management and complication was done.
Conclusion :
. Current study revealed that there is a high prevalence of placenta previa in our locality about 17,3% , most of these cases belong to scared uterus group 63,6% .
. Placenta accreta is very common between scared group , it represent 30,1% of cases while only 3,4% of non scared cases were placenta accreta .
. T.V.S is the standard device in diagnosis of placenta previa ,while MRI is done to establish diagnosis of placenta accreta .
. Most of cases diagnosed to be placenta previa at the first part of third trimester ,where they come in labor or complaining of APHg .
. Placenta previa centralis is the commonest in scarred cases 46,6% ,while placenta previa degree II is the commonest in non scarred cases 30,5% .
.scared uterus has a great effect on maternal outcome :
. Hysterectomy was done in 29,1% of cases in scarred group and 3,4% of non scarred cases .
. All cases of bladder injury occurred in scarred cases group 11.7%.
. preparation of cross matched blood is very important as all cases of scarred group and 93,2% of non scarred cases received blood intra operative .
. The only case of maternal death belongs to scarred uterus cases group.
Recommendations:-
1- Placenta previa is very common in our locality , so we must save all facilities in our tertiary care centers to be ready at any time to deal with these cases .
2- Routine follow up during early pregnancy and maternal education is very important to avoid complicated cases , as most of the cases were detected late at third trimester and after attacks of bleeding or uterine contraction .
3- TVS proved to be effective in diagnosis of placenta previa ,MRI is done to establish the diagnosis of placenta accreta .
4- Early investigation and treatment of anemia during pregnancy is very important to avoid intra or post partum complications .
5-There is agreat impact from prvious CS on the prevalence of placenta previa and placenta accreta , so the best strategy to manage placenta previa or placenta accreta is to reduce the incidence from the start .
6- Most of placenta previa cases specialy scarred one are at risk of preterm labour , so antepartum steroid for lung maturation is very important , and preparation of good NICU .
7-As most of patients are prone to repeated attacks of bleeding , so admission in atertiry care center with availability of cross matched blood is highly recommended . .
8-Well experienced obstetrician must do the operation ,experianced anaethetist and urology team must be available during the operation.
9-The best management of placenta previa in degree III and IV is cs ,while if the distantce of placental edge to internal os is more than 2 cm, trial of vaginal delivery is preferred
10-The best treatment for placenta previa accreta is hysterectomy , but conservative management may be tried in special cases .
11-Some haemostatic measures such as uterine artery ligation , internal iliac artery ligation, haemostatic stitches at placental bed , intra uterine catheter and packing , proved to be effective in decreasing amount of blood loss in a large number of cases.