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Article
Antenatal diagnosis of myometrial invasion in anterior placenta previa by transabdominal color Doppler ultra sound

Author: Jwan N. Sulaiman جوان نجيب سليمان
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 27-32
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The incidence of maternal mortality inplacenta previa accrete is 7%,and its preoperativediagnosis is of a great value.Objective: to evaluate the efficacy of transabdominalcolor Doppler ultrasound in diagnosing placentaprevia accreta and inccreta. Color Doppler imagingcriteria used in: includes diffuse parenchymalplacental lacunar flow, focal intra parenchymalplacental lacunar flow and bladder uterine serosainterphase hyper-vascularity.Design: Prospective study on patients fromJanuary2007 to January 2008.Patients and method: 48patients with one caesareansection or more and with persistent anterior placentaprevia diagnosed by transabdominal ultrasound wereexamined by color Doppler at 32 or more weeks ofgestation to determine the possibility of myometrialinvasion depending on the above color Dopplercriteria.Results: Out of 48 patients eleven exhibitedcharacteristic Doppler imaging pattern highly specificfor placenta accreta and inccreta according topreceding criteria , one patient had false positive colorDoppler imaging result, 5 patients underwentcaesarian hysterectomy , the remaining five weretreated conservatively by uterine artery ligation andother conservative measures because of bleedingfrom the lower uterine segment.Conclusion Color Doppler sonography is highlysensitive andspecific in the antenatal diagnosis of placenta previaaccreta .If a strong suspicion is found before delivery,appropriate location and timing for delivery should beconsidered ,to allow access to adequate surgicalpersonel and equipment ,preoperative bloodpreparation to reduce morbidity and mortality.Journal titleUltrasound in obstetric and gynecology ISSUN 0960-7692 Source 2000 Vol 15 In 1 PP. 28-35 (22rel)


Article
Placenta Accreta

Author: Zahida Al-Saadi * M RCOG زاهدة السعدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 2 Pages: 1-4
Publisher: Baghdad University جامعة بغداد

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Abstract

Placenta accrete is defined as an abnormally adherent placenta that is directly attached to the myometrium because of inadequate development of the fibrinoid layer (Nitabuch layer) and absence of decidua basilis either partially or totally. (1) Three degrees of placenta accrete exist depending on the depth of villous invasion: placenta accreta is when villi become attached to myometrium, placenta increta: the villi invade the myometrium, placenta percreta represents the greatest degree of severity where placental villi penetrate throughout myometrium and peritoneum extending sometimes to adjacent structure such as the bladder. (1, 2, 3)Placenta accreta accounts for 78% of cases, increta for 17% and percreta 5-7 %.( 4) Massive obstetric hemorrhage is still the leading cause of pregnancy related deaths, and placenta previa accreta remains one of the serious predisposing factors. (5)The problem occurs when there is abnormal separation of placenta in 3rd stage of labor, and attempts to deliver the placenta may provoke massive blood loss that may necessitate hysterectomy. (2)With the increasing rate of cesarean section the incidence of both placenta previa and placenta accreta is steadily increasing in frequency, (3, 4) we therefore anticipate more cases of placenta previa accreta.In several recent series, placenta accreta has emerged as the major indication for peripartum hysterectomy, accounted for 40-60% of cases. (7),It is not always clinically possible to differentiate between the three types of placenta accreta.Placenta accreta is not usually suspected when the placenta is normally situated, but antenatal diagnosis is possible when placenta accreta is previa. Accreta invasion may involve whole placental cotyledons, or partial (several cotyledons), or focal as one or two cotyledons.

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