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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: To assess the efficacy of intravenous tranexamic acid and ethamsylate in reducing blood loss during and after elective lower segment cesarean delivery in patients at high risk for postpartum hemorrhage. Methods: A double-blind, randomized placebo-controlled study was undertaken of women undergoing elective lower-segment cesarean delivery of a full-term pregnancy at high risk for postpartum hemorrhage at Ain Sham University Maternity Hospital in Cairo, Egypt, between January 2019 and October 2019. Patients were randomly assigned (1:1) using computer-generated random numbers to receive either 1 g tranexamic acid and 1 gm ethamsylate or 5% glucose (placebo) just after delivery of the fetus. Prophylactic oxytocin was administered to all women. Preoperative and postoperative complete blood count, hematocrit values, and maternal weight were used to calculate the estimated blood loss (EBL) during the cesarean, which was the primary outcome. Results: Analyses included 32 women in each group. Our results showed that tranexamic acid and ethamsylate significantly reduced bleeding during and after cesarean delivery. The study group's total blood loss (149.22 ± 54.74 ml) was significantly less than the control group (353.75 ± 115.56 ml) (p < 0.001). In our study, postoperative hemoglobin and hematocrit were significantly higher in the study group than the control group (p < 0.001); Reduction in hemoglobin and hematocrit were significantly less in the study group than the control group (p < 0.001). Conclusion: The use of tranexamic acid and ethamsylate during cesarean delivery can significantly reduce blood loss during and after cesarean delivery.