COMPARISON BETWEEN INTRAOPERATIVE FEATURES OF MORBIDLY ADHERENT PLACENTA WITH PRENATAL ULTRASONIC FEATURES 

Juanita Salah Ahmed a, Ariana Khalis Jawad b, and Huda Muhaddien Muhammad c



a  KBMS Candidate, Obstetrics & Gynecology, Sulaimania Maternity Hospital, Kurdistan Region /Iraq. 
b Department of Obstetrics & Gynecology, College of Medicine, Erbil Medical University, Kurdistan Region /Iraq. 
c Department of Obstetrics and Gynecology, College of Medicine University of Sulaimani, Kurdistan Region /Iraq.
 

Submitted: 7/6/2019; Accepted: 17/2/2020; Published: 21/3/2020

ABSTRACT


Background 

The term morbidly adherent placenta characterized by abnormally implanted, invasive, or adhered placenta, which is increasing in obstetrical practice mainly due to increasing rate of cesarean section associated with increasing mortality and morbidity which can be avoidable by good assessment by ultrasound before operation.


Objectives 

The aim of this study was to assess the diagnostic accuracy of pre-natal ultrasound in detecting morbidly adherent placenta in patients at risk.


Materials and Methods

Prospective observational study, case sheets of 125 women reviewed having placenta previa and previous uterine surgery (CS, myomectomy or curettage) from May 2018 to May 2019, population included 38 pregnant women. All cases of complete placenta previa or low-lying placenta, scans performed through either trans abdominal ultrasonography or transvaginal ultrasonography in their second and third trimesters of pregnancy, signs were loss of clear zone, placental lacunae, myometrial thinning, placental bulge, focal exophytic mass, and bladder wall interruption with the availability of more than three finding regarded as highly suspicious and final diagnosis made during cesarean section.


Results

Among 38 patients with risks, there was a significant correlation between increasing age and extend of morbidly adherent placenta. The average gestational age of the patients was 36.2 weeks, ranging from 20-39.3 weeks. All cases at least underwent prior caesarean delivery. There was increasing incidence of MAP with increasing number in C/S. In women with risk of MAP along with highly suspicious ultrasound findings, fourteen cases underwent hysterectomy, uterus-sparing alternatives to manage this condition can be an option in selected cases, the most reliable signs for suspecting percreta were placental bulge, focal exophytic mass, and bladder wall interruption, the sensitivity and positive predictive value was 70% and 90% respectively. 


Conclusion

Management with prediction of MAP by ultrasonography is useful for obtaining permissible morbidity.



KEYWORDS

Morbidly adherent placenta (MAP), Placenta accreta, increta, percreta, Ultrasound imaging, Prenatal diagnosis, Cesarean section (C/S).