Role of Three‐dimensional Power Doppler Ultrasonography in Diagnosis of Placenta Accreta Versus Two‐dimensional and Color Doppler Ultrasonography

Abstract

Background: Placenta accreta is a condition of abnormal placental implantation in which the placental tissue invades beyond the decidua basalis. It may invade into or even through the myometrium and adjacent organs, such as the urinary bladder. It is a major cause of obstetric hemorrhage and complication leading to significant maternal morbidity and mortality. The aim of this study is to compare the role of three-dimensional power Doppler ultrasonography in the antenatal diagnosis of placenta accreta versus two-dimensional and color Doppler ultrasonography. Methods: A prospective comparative study design was conducted. This study was performed on 50 Pregnant females at the Department of Obstetrics and Gynecology, Tanta University Hospitals Inclusion Criteria: Patients with placenta previa and previous one or more ceserian section at gestational age from 28 weeks to 36 weeks. The diagnosis of placenta previa confirmed using all diagnostic techniques (gray scale, color Doppler, and 3D power Doppler) and full availability of delivery information. Results: abnormal placental lacunae was most frequently encountered in 2D gray scale ultrasound as it was noted in 12 (24.0%) patients, thinning or disruption of hyperechoic serosa-bladder interface was detected in 8 (16.0 %) patients, loss of retroplacental sonolucent zone was detected in 7 (14.0 %) patients, irregular retroplacental sonolucent zone was noted in 5 (10.0%) patients, while presence of focal exophytic masses invading the urinary bladder was the least encountered as it was noted in 4 (8.0 %) patients. The 2D gray scale initially diagnose 52.0% of study participants as placenta accreta and 48.0% as had no placenta accreta.   Conclusions: There is no one imaging modality that provides the gold standard for diagnosing placental invasion. A high index of clinical suspicion is required for its detection in high risk patients. In contemporary obstetrical practice, this applies to patients with previous caesarean sections, and especially if there is a coexisting anterior low-lying placenta. A probable case of morbidly adherent placenta will benefit from preoperative multidisciplinary input and perioperative measures in preparation for an elective planned delivery