Placenta accreta occurs when placental trophoblasts invade the endometrium beyond the Nitabuch's layer of decidua basalis, placenta increta occurs when placental trophoblasts invade the myometrium, and placenta percreta occurs when placental trophoblasts invade the serosa (1, 2). Morbid adherent placenta (MAP) is generally associated with excess blood loss, bladder injuries and hysterectomies (3, 4). The incidence of MAP has increased significantly over the last 50 years (5, 6). A past history of a cesarean delivery, placenta previa, and damage of the Nitabuch's layer of decidua basalis following intrauterine infection or scarring are the risk factors of MAP. The incidence of MAP is increased concomitantly with increased cesarean section rates (1, 7-9). The incidence of MAP is 3.3% in pregnant women with no past history of cesarean delivery and placenta previa and is 40% in pregnant women with a history of two cesarean sections and placenta previa (4). If MAP was diagnosed or suspected before delivery, the optimum time for planned delivery is around 34-35 weeks, following a course of corticosteroids and multidisciplinary team care approach (2, 10, 11). An accurate diagnosis of MAP is essential to prepare both the patient and health providers for possible complications during delivery. Authors reported that ultrasound is a useful tool to diagnose MAP, with 77%-93% sensitivity and 71%-98% specificity (12-16). Moodley et al. (17) concluded that the color flow Doppler was more specific, with a 95% negative predictive value (NPV) in the prenatal diagnosis of MAP, than magnetic resonance imaging (MRI), and MRI should be reserved for cases with inconclusive sonographic findings (13,15,17). The sonographic markers of placenta accreta can be seen in the first trimester of pregnancy in the form of low implantation of the pregnancy sac and multiple vascular spaces within the placenta (2). Prenatal diagnosis of MAP with gray-scale and Doppler sonography allows the development of the multidisciplinary team care approach during delivery (14). This current study aimed Objective: To detect the accuracy of the three-dimensional multislice view (3D MSV) Doppler in the diagnosis of morbid adherent placenta (MAP). Material and Methods:Fifty pregnant women at ≥28 weeks gestation with suspected MAP were included in this prospective study. Two dimensional (2D) trans-abdominal gray-scale 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 MSV Doppler 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 MSV Doppler in the diagnosis of MAP. Results:The 3D MSV Doppler increased the accuracy and predictive values of the diagnostic criteria of MAP compared with the 3D power Doppler. The sensitivity and negative predictive value (NPV) (79.6%...

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Objective: This study designed to evaluate outcomes and accuracy of 2D gray-scale ultrasound scan in prenatal diagnosis of Morbid Adherent Placenta (MAP). Patients and methods: Fifty pregnant women ≥28 weeks gestation with suspected MAP studied. 2D trans-abdominal gray-scale ultrasound scan done for studied women to confirm; placental location and findings suggestive of MAP. Intra-operative findings at delivery compared with pre-operative sonographer findings to evaluate outcomes and accuracy of 2D gray-scale ultrasound scan in prenatal diagnosis of MAP. Results: 56%(28/50) of studied women had difficult placental separation, considerable intraoperative blood loss. Bilateral internal iliac artery ligation done to control bleeding in 28%(14/50), intrauterine compression balloon with placenta bed sutures done in 6%(3/50) and cesarean hysterectomy done in 22%(11/50) of studied women. Best 2D gray-scale ultrasound parameters for detection of difficult placental separation and considerable intraoperative blood loss in studied cases were; abnormal placental lacunae (73.9% sensitivity) and exophytic mass invading bladder (100% specificity & 100% PPV). Best 2D gray-scale ultrasound parameters for detection of emergency hysterectomy were; disruption of uterine serosa-bladder interface (81.8% sensitivity) and exophytic mass invading bladder (94.9% specificity, 66.7% PPV and 84.1% NPV). Conclusion: Antenatal diagnosis of MAP is crucial for; proper counseling for possible surgical complications, multidisciplinary team care and recruitment. Best 2D gray-scale ultrasound parameters for detection of difficult placental separation in studied cases were; exophytic mass invading bladder, while, best 2D gray-scale ultrasound parameters for detection of emergency hysterectomy were; disruption of uterine serosa-bladder interface and exophytic mass invading bladder.