title: Prevalence and diagnostic accuracy of Doppler ultrasound of placenta accreta in Egypt.
abstract: OBJECTIVE
  The objective of this study is to assess the prevalence of placenta accrete (PA) among those with placenta implanted over cesarean section (CS) scar and to evaluate the accuracy of Doppler ultrasound in diagnosis.
  
  
  METHODS
  A cross-sectional study included 100 patients with placenta previa (PP) anterior with at least one previous CS. Ultrasound and color Doppler were done to all participants and correlated with operative findings.
  
  
  RESULTS
  There was a significant difference between accrete and non-accrete group regarding maternal age (32.6 ± 5.01 versus 29.14 ± 4.89), and a highly significant difference regarding the postoperative hemoglobin (6.71 ± 1.156 versus 8.41 ± 1.257) and the number of previous CSs (p <.001). The abnormal Doppler findings showed a highly significant difference between the two groups as loss of retroplacental clear zone (87.3% versus 10.8%), intraplacental lacunae (93.7% versus 37.8%), hypervascularity in uterine bladder interface (47.6% versus 5.4%), and blood vessels invading myometrium (82.5% versus 18.9%) (p < .001). The sensitivity, specificity, PPV, NPV, and accuracy of loss of retroplacental clear were 87.3%, 89.19%, 93.2%, 80.49%, and 88%; intraplacental lacunae were 93.65%, 62.16%, 80.82%, 85.19%, and 82%; hypervascularity in uterine bladder interface were 47.62%, 94.59%, 93.75%, 51.47%, and 65%; dilated vessels over peripheral subplacental zone were 82.54%, 81.08%, 88.14%, 73.17%, and 82%, respectively. There was a highly significant difference between the two groups regarding surgical management with cesarean hysterectomy, occurrence of bladder injury, the need for intraoperative, and postoperative blood transfusion, ICU admission (p < .001).
  
  
  CONCLUSIONS
  The use of ultrasound together with the color Doppler allowed for better prediction of placental invasion of the myometrium prior to obstetrical intervention to improve the maternal and the fetal outcome.
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Maged
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Hoda
authors.initials: H
authors.lastname: Abdelaal
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Emad
authors.initials: E
authors.lastname: Salah
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Hany
authors.initials: H
authors.lastname: Saad
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Hadeer
authors.initials: H
authors.lastname: Meshaal
authors.affiliation: a Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Eldaly
authors.affiliation: b Department of Obstetrics and Gynecology , Beni-Suef University , Beni-Suef , Egypt.
authors.forename: Maha A
authors.initials: MA
authors.lastname: Katta
authors.affiliation: c Department of Obstetrics and Gynecology , Fayoum University , Fayoum , Egypt.
authors.forename: Wesam S
authors.initials: WS
authors.lastname: Deeb
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects; D002921:Cicatrix / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011247:Pregnancy; D015995:Prevalence; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Placenta accreta; cesarean hysterectomy; color Doppler; ultrasound