Background: The aim of our study was to evaluate the accuracy of Three Dimensional Tomographic Ultrasound Imaging (3D-TUI) and 3D power Doppler using Alalfy simple criteria in the diagnosis of placenta previa and PAS (Placenta accrete spectrum) with differentiation of placenta previa (non-adherent placenta) from PAS disorders and determination of its subtypes (Accreta, increta, and percreta). Methods: A prospective observational study that included 90 pregnant women was made at Algezeera Hospital, Egypt. A systematic combined approach using Alalfy simple criteria; with applying the ultrasound criteria suggestive of PAS in the 3D-TUI, and 3D power Doppler ultrasound volume was performed to scan the placenta previa and to assess if it is non-adherent or PAS and to determine its subtype (accreta, increta or percreta). Results: The study shows a high agreement between the 3D-TUI with 3D power Doppler US using Alalfy simple criteria and the operative findings in the diagnosis and differentiation of placenta previa (non-adherent) from PAS (adherent) and its subtypes. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the 3D-TUI cuts in diagnosing adherent from non-adherent were 100%, 100%, 100%, 100% and 100%, respectively. 3D TUI-cuts has a diagnostic accuracy of 98.8 percent when compared to operative findings in accurately determining the exact subtype of placenta accreta spectrum. Conclusion: The systematic combined approach using Alalfy Simple Criteria for assessment of placenta previa and PAS that entails applying the ultrasound criteria suggestive of PAS in the 3D-TUI—3D power Doppler volume has a high degree of accuracy in the diagnosis of PAS from non-adherent placenta and in accurately diagnosing the subtype of PAS (accreta, increta or percreta). 3D-TUI-cuts facilitates the evaluation of the myometrial thickness and the depth of placental invasion with much better differentiation between different subtypes of PAS with better identification of focal from diffuse invasion with the ability of 3D power Doppler to delineate the vessels invading a part of the myometrium or the whole myometrium, and bridging vessels and high vascularity.

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New corona virus disease COVID-19 is a pandemic outbreak viral infection that is highly contagious. The disease can affect any age groups. Majority of patients show mild or no symptoms. Immunocompromised patients and patients with co-morbidities are more vulnerable to have more aggressive affection with higher rate of complications. Thus, cancer patients carry a higher risk of infection. Diseased patient can transmit infection throughout the disease course starting from the incubation period to clinical recovery. All healthcare workers contacting COVID-19-positive patients are at great risk of infection, especially the anesthesiologists who can be exposed to high viral load during airway manipulation. In the National Cancer Institute of Egypt, we apply a protocol to prioritize cases where elective cancer surgeries that would not affect patient prognosis and outcome are postponed during the early phase and peak of the pandemic till reaching a plateau. However, emergency and urgent surgeries that can compromise cancer patient’s life and prognosis take place after the proper assessment of the patient’s condition. Aim This review aims to spot the management of cancer patients undergoing surgery during the COVID-19 pandemic in the National Cancer Institute, Egypt.

Objective: Studying the correlation of different lung parameters, using three dimensional ultrasound (3D US) with fetal lung maturity (FLM) to predict the development of neonatal respiratory distress syndrome (RDS). Methods: Three dimensional ultrasound was done to record the fetal lung volume (FLV), Fetal lung to liver intensity ratio (FLLIR) & the main pulmonary artery (MPA) blood flow parameters; pulsatility index (PI), resistive index (RI) and acceleration time -to- ejection time ratio (At/Et), to 218 women between 32 to 40 weeks gestational age within 24 h from labor. Results: Of 218 fetuses examined, final analysis was done for 143 fetuses. Thirty eight (26.5%) were diagnosed with RDS. The MPA PI and RI were significantly higher in fetuses diagnosed with RDS compared with those without (2.51 ± 0.33 and 0.90 ± 0.03 cm/s versus 1.96 ± 0.20 and 0.84 ± 0.01 cm/s; p value < 0.001 and <0.001 respectively). MPA At/Et was significantly lower (0.24 ± 0.04 vs 0.35 ± 0.04; p value < 0.001). FLLIR was significantly lower (1.04 ± 0.07 vs 1.18 ± 0.11; p value < 0.001), and the mean FLV which was significantly smaller (28.23 ± 5.63, vs 38.87 ± 4.68 cm3; p value < 0.001). Conclusion: Main pulmonary artery (PI, RI, At/Et ratio), FLIIR, and mean FLV can be used as reliable predictors of neonatal RDS. Advances in knowledge: 3D ultrasound VOCAL technique, ultrasound tissue histogram and pulmonary artery Doppler are reliable tools for prenatal prediction of fetal lung maturity.

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