الفهرس 
Acknowledgement
Placental developmentOnly 14 pages are availabe for public view
 |  | from | 81 |  |  |
| | | from | 81 | | |
Abstract
Although relatively rare, placenta previa and accreta 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 obstetric bleeding.
Our aims in this work were estimation of prevalence of placenta accreta in cases of placenta previa, evaluation of u/s (2D/3D) in diagnosis of placenta accreta (by histopathological examination after operation), role of previous cessarian section in placenta accreta (in cases of placenta previa) & relation of fetal weight and maternal age with placentaaccreta.
This prospective study included 115 cases, Recruited from women’s health hospital-Assiut university on singletonpregnancies
After 28 weeks gestation the mean number of age in the risky group was 29.8±5.2&in the non risky group 26.5±6.
Diagnosis was done. With 2D gray-scale transabdominal and transvaginal ultrasonography (placental lacunae hypoechoic line myometrial thickness at site of scar) were obtained &With3D, color doppler.(branching vessels &vascularity) were also evaluated Neonatal assessment was done by birth weight and Apgar score.
Results of the current study show the descriptive data of the study group age of patients ranged between 18 and 40 years the mean in the risky group was 29.8±5.2&in the non risky group 26.5±6.Their gestational age ranged between 28 and 40 weeks with mean of 34.28
27 patients (37%) had evidene of accrete in the risk group and 4 patients(26.7%) in non risk group.
Results of the current study show that Evidence of accrete before and after surgery among the cases was nearly the same which emphasise that Ultrasound and color Doppler examination are the first-step for the diagnosis of placenta accreta. (WarshakCR, et al 2006)
In our study histopathological examination was performed to the patients who undergone hysterectomy {10 cases} in our study which all confirmed the diagnosis of placenta accrete (revealed invasion of the chorionic villi into the myometrium).
In Conclusion:Focal accreta surgery
2D is a good tool for prediction of placenta accreta with a Sensitivity of 70.4 %and Specificity of 86.3 %and PPV of 65.5% and NPV of 88.7% and with Accuracy 82.0%
But 3D and Doppler more superior than it with a Sensitivity of 100 and Specificity of 83.6% and PPV of 69.2% and NPV of 100% and with Accuracy 88.0%
Total accreta surgery:
2D equal 3D and Doppler with a Sensitivity of 100% and Specificity of 100% and PPV of 100% and NPV of 100% and with Accuracy 100%.
Percreta surgery:
2D is a good tool for prediction of placenta accreta with a Sensitivity of 66.7% and Specificity of 98.9% and PPV of 80.0% and NPV of 97.9% and with Accuracy 97.0% .
But 3D and Doppler more superior than it with a Sensitivity of 83.3% and Specificity of 98.9% and PPV of 83.3% and NPV of 98.9% and with Accuracy 98.0% .
Using Roc curve of myometrial thickness to detect focal accrete the Best cutoff was <0.9 that means patients with myometrial thickness <0.9 at agreat risk for placenta accreta with with a Sensitivity of 96.3% and Specificity of 97.3% and PPV of 92.9% and NPV of 98.6% and with Accuracy 97.1% .
Using Roc curve of myometrial thinkness to detect focal prcreta the BEST cutoff was <0.9 that means patients with myometrial thickness <0.9 at agreat risk for placenta accreta with with a Sensitivity of 83.3% and Specificity of 95.7% and PPV of 55.6% and NPV of 98.6% .and with Accuracy 90.5%