Evaluation of Different Ultrasonographic Modalities in the Diagnosis of Morbidly Adherent Placenta: A Cross-Sectional Study

Abstract

Objective: To compare the accuracy of different ultrasonographic modalities; two-dimensional ultrasound (2D-US), color Doppler and three-dimensional power Doppler (3D-PD) in the antenatal diagnosis of the morbidly adherent placenta. Setting: Obstetrics and Gynecology Department, Faculty of Medicine, Assiut University, Assiut, Egypt. Study Design: A cross-sectional study. Methods: All patients fulfill the inclusions criteria: gestational age > 28 weeks, previous one or more cesarean delivery, previous uterine surgery, placenta previa, vitally stable patient and women accepted to participate in the study were included. All patients were evaluated using 2D-US, color Doppler and 3D-PD before delivery. The final diagnosis was established by laparotomy and by histopathology of hysterectomy sample if hysterectomy would be done. Results: One-hundred fifty patients were enrolled in the study. 2D-US has higher sensitivity (86.96%) than 2D color Doppler (84.06%) and 3D-PD (79.71%) in the diagnosis of placenta accreta. On the other hand, 3D-PD has slightly higher specificity (83.95%) than color Doppler (82.72%) and 2D-US (77.78%) in the diagnosis of placenta accreta. The most sensitive parameter in 2D-Us was the loss of retroplacental sonolucent zone (86.96%). As regards color Doppler, the most sensitive parameter was the hypervascularity of the uterine-bladder interface (84.06%). Tortuous vascularity with chaotic branching was the most sensitive parameter in 3D-PD with a sensitivity of 82.61%. Conclusions: The use of 3D power Doppler with both 2D-US and color Doppler as complementary techniques could improve the antenatal diagnosis or exclusion of morbidly adherent placenta.