Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Radio-diagnosis

Background: Morbidly adherent placenta is abnormal placental adherence or invasion of the myometrium or extra uterine structures. It is increasing in incidence because of increasing number of cesarean sections and is one of the main causes of excessive postpartum hemorrhage. The application of Tomographic Ultrasound Imaging is used for the visualization of the depth of placental invasion. Preoperative ultrasound diagnosis allows appropriate preoperative preparations and the decision to leave the placenta untouched to avoid a probable fatal outcome for the patient. Objective: To detect the accuracy of the three-dimensional tomographic imaging (3D TUI) &Doppler in the diagnosis of morbidly adherent placenta (MAP). Patient and method: Twenty three pregnant women at {u2265}34 week's gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale and color Doppler ultrasound scan was performed for the subjects to confirm the gestational age, placental location, and findings suggestive of MAP, followed by the 3D power Doppler and then the 3D TUI to confirm the diagnosis of MAP. Intraoperative findings and histopathology results of removed uteri in cases managed by emergency hysterectomy were compared with preoperative sonographic findings to detect the accuracy of the 3D TUI in the diagnosis of MAP Results: The 3D TUI increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 2D gray scale. The sensitivity and negative predictive value (NPV) (75% and 78.57%, respectively) of myometrial thinning to detect difficult placental separation and considerable intraoperative blood loss in cases of MAP using the 2D gray scale was increased to 100% and 100%, respectively, using the 3D TUI . In addition, the accuracy 91.30% of crowded vessels over the peripheral sub- placental zone to detect difficult placental separation by 2D Doppler for the detection of emergency hysterectomy in cases of MAP using the 3D power Doppler was increased to 100% respectively, using the 3D power Doppler. Conclusion: The 3D TUI is a useful adjunctive tool to the 3D power Doppler or color Doppler to refine the diagnosis of MAP

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