الفهرس 
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Abstract
SUMMARY
P
lacenta previa is a severe complication of pregnancy and is the most common cause of postpartum hemorrhage, which often endangers the lives of pregnant women. In recent years, an increasing number of researchers believe that the placenta previa position has an important influence on the pregnancy outcome.
Previous studies have suggested that placenta previa is often a risk factor for placenta accreta. Depending on histopathology, Placenta accreta spectrum (PAS) is classified into three groups: placenta percreta in which the uterine serosa is penetrated by the chorionic villi, placenta increta in which the chorionic villi invade the myometrium, and placenta accreta in which the chorionic villi are in touch with the myometrium.
Ultrasonography (US) remains the diagnostic standard, and routine US examination at 18–20 weeks gestation affords an ideal opportunity to screen for the disorder. Color Doppler appears to improve the diagnostic accuracy of grey-scale ultrasound techniques and must be used freely in situations where there is a high guide of doubt for placenta praevia. Its accuracy, when combined with 2D Ultrasound, would increase and provides the best available modality for diagnosis of placenta accreta.
Three-dimensional power Doppler was targeted to detect angio construction in the basal and lateral views of the placenta. Three-dimensional power Doppler may be valuable as a complementary method for the antenatal diagnosis or elimination of placenta accrete.
Accurate prenatal identification of affected pregnancies allows optimal management because timing and site of delivery, availability of blood products, and recruitment of a skilled anesthesia and surgical team can be arranged in advance.
This was cross sectional study (prospective) study, was carried out in Gyncology and Obstetric Department at Dessouq hospital, Kafhr ELSheikh government, Eygpt, on 26 pregnant women with placenta previa and previous cesarian scar during a period of 6 months to test the role of gray scale and color doppler in antenatal assessment of plaventa previa accreata in patients with perivious ceaarean ascsn and comparing data with operating rooms.
We found that regarding US have high senisity and specificity for prediction each type of placental disorders from others. As follows regarding P. Accreta Sensitivity was 85.71, Specificity was 100.00, PPV was 100.00, NPV was 85.71. regarding P. Increta Sensitivity was 88.89, Specificity was 100.00, PPV was 100.00 and NPV was 94.44. Regarding P. Percreta Sensitivity was 100.00, Specificity was 100.00, PPV was 100.00 and NPV was 100.00. US remains the primary screening modality of PA. 2D Gray scale has higher sensitivity than color Doppler in diagnosis of placenta accreta. The presence of Irregular retro-placental sono lucent zone had the highest sensitivity for detection of PA.
We recommend for further studies on larger patients and longer period of follow up to emphasize our conclusion.
CONCLUSION
I
n conclusion, the prevalence of PA is increasing, and practitioners should be aware of this entity and its imaging features. Placenta previa and a prior history of cesarean section are the most significant risk factors for PA. US remains the primary screening modality of PA. 2D Gray scale has higher sensitivity than color Doppler in diagnosis of placenta accreta. The presence of Irregular retro-placental sono lucent zone had the highest sensitivity for detection of PA.
RECOMMENDATIONS
• Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
• Further prospective studies are needed to evaluate better this technique and confirm our findings.
• Antenatal diagnosis of placenta accreta is mandatory to overcome the maternal and fetal morbidity and mortality.
• Thus it is suggested to use both Gray scale ultrasound and Color Doppler in all cases of placenta previa with previous C.S to find out features that suggest presence of placenta accreta. This allows the surgical team to deal with emergency condition and prepare for potential bleeding
• MRI is often recommended when ultrasound findings are questionable.