الفهرس 
M ORBIDLY A DHERENT P LACENTAOnly 14 pages are availabe for public view
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Abstract
Abstract
Background: The incidence of placenta accreta should rise steadily over the next century as the frequency of cesarean sections and advanced maternal age, both independent risk factors, increases. The diagnosis of placenta previa accreta is possible by using gray-scale sonography, conventional color Doppler imaging and MRI through studying the relation of placenta to the uterine wall and nearby pelvic structures.
Objective: The aim of the study is to evaluate the diagnostic accuracy of a new ultrasound sign, which has been named “intracervical lakes ICL”, in predicting presence and outcome of PAS disorders.
Patients and Methods: A prospective observational study of 110 women with placenta previa or low-lying placenta at ≥36 weeks gestation, who were referred to Ain Shams University Maternity Hospital between 1st of January 2021 till the end of December 2021. All patients were evaluated by 2D & color doppler Ultrasonography to confirm the gestational age, placental location, criteria for invasion (Loss of the clear zone, abnormal placental lacunae, bladder wall interruption, myometrial thinning and 2D color doppler) and presence of intracervical lakes sign. All patients in the study underwent caesarean section and final diagnosis of morbidly adherent placenta (MAP) was made intraoperative and specimens were sent for pathological examination.
Results: As regard radiological findings suggestive of PAS alone; they had moderate diagnostic sensitivity 76.8 % and specificity 85.2 %, while PAS signs + ICL had higher specificity up to 98.1 % with positive predictive value 96.2 %, Positive likelihood ratio (LR+) 24.11 % and Diagnostic odds ratio (DOR) 42.74, As regard Diagnostic characteristics of radiological findings in predicting percreta; PAS sign alone had high sensitivity 95.2 % & NPV 98.3 %, and moderate other diagnostic characteristics, PAS sign+ ICL not markedly decreased sensitivity 90.5% and NPV 97.6 %, but markedly increased other diagnostic characteristic for predicting severity of pre and intraoperative blood loss and need for hysterectomy with specificity 92.1%.
Conclusion: intracervical lakes can be used as a marker of deep villus invasion in women with suspected PAS disorder on antenatal ultrasound and anticipate the occurrence of severe maternal morbidity with specificity 98.1