Outcomes and Accuracy of 2D Gray-Scale Ultrasound Scan in Prenatal Diagnosis of Morbid Adherent Placenta

Abstract

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.