Background: Placenta accreta spectrum is a term which describes abnormal invasion of the placenta into the uterine myometrium. The first line in diagnosis is ultrasonography and magnetic resonance imaging may complement the diagnosis. Aim: The aim of the work is to assess the accuracy of shear wave elastography in predication of placental invasion in women with placental previa. Materials and Methods: This is a prospective cohort study which was conducted in Ain Shams University on 50 women with a diagnosis of anterior placenta previa and history of previous cesarean section who were pregnant at 32 weeks or more and were planned for delivery by elective cesarean section. They were subjected to ultrasonography and elastography study and the diagnosis of placenta accreta spectrum was confirmed/ excluded intraoperatively. Results: Placental separation was normal in 36% of cases, delayed in 46 % of cases, partial in 6% of cases only whereas non separation occurred in 12% of cases. elastrgraphy had a sensitivity of 73.7%, specificity of 90.3%, positive predicting value of 82.4% and negative predictive value of 84.8% in diagnosing cases with abnormal placental invasion while sensitivity, specificity positive and negative predictive value of ultrasonography in diagnosing abnormal placental invasion was 89.5%, 96.8%, 94.4% and 93.8% respectively. Conclusion:Elastography is sensitive and specific but inferior to ultrasonography in evaluating women with suspected placenta accreta spectrum but it may be useful in diagnosis of focal invasion.

Background: Rupture of membranes is associated with high incidence of maternal and fetal morbidities as well as the neonatal morbidity and mortality resulting from prematurity if preterm birth ensues. Aim: This study aimed to evaluate maternal and neonatal outcomes of elective delivery at 34 versus 36 weeks of gestations in pregnancies complicated by preterm premature rupture of membranes and had been managed expectantly. Materials and Methods: This is a prospective randomized controlled trial which was conducted at Ain Shams University Maternity hospital between March and August 2019. 140 women pregnant between 30 and 32 weeks and diagnosed with preterm premature rupture of membranes were admitted to receive conservative management and then they were randomly divided into 2 equal groups regarding time of elective delivery either late delivery at 36 weeks or early delivery at 34 weeks. Results: The incidence of intrauterine infections was comparable between both groups. The rate of chorioamnionits was 8.6% in the late delivery group versus 4.3% in the early delivery group while endometritis was diagnosed in 2.9% in the late delivery group and 1.4% in the early delivery group. The incidence of spontaneous onset of preterm labor, cord prolapse and placental abruption was similar in both groups. Neonates of the late delivery group had significantly more Apgar score at 5 minutes (6.4±1.0 versus 5.0±0.9, p<0.001) and more birth weight (2388.6±240.3 versus 2173.7±231.5, p<0.001) in addition to significantly less incidence of respiratory distress syndrome (2.9% versus 11.4%, p = 0.049) and fewer neonatal intensive care unit admissions (27.1% versus 54.3%, p = 0.002). The frequency of neonatal infections was higher in the late delivery group but this difference was not significant statistically (5.7% versus 2.9%, p>0.05). Conclusion:Early delivery at 34 weeks does not reduce the rate of chorioamnionitis, but does increase the likelihood of respiratory distress syndrome and the rate of neonatal intensive care unit admissions. Our findings support the practice of conservative management in pregnant women with ruptured membranes if there is no contraindication to extending the pregnancy.