Background: Accurate diagnosis of morbidly adherent
placenta (MAP) and differentiation between its variants
accreta, increta and percreta, allows preparation of life saving measures, and enables planning for alternative surgical
procedures saving the future fertility according to the severity of the case.
Objective: Evaluate the accuracy of 2D, color Doppler,
3D and 3D power Doppler in the assessment of Morbidly
Adherent Placenta (MAP) and the introduction of designed
ultrasound-history based scoring system for prenatal diagnosis of (MAP), and differentiation between its variants in
patients with previous cesarean section (CS) scar/s in correlation with the intraoperative findings.
Materials and Methods: Ninety five pregnant women with
persistent placenta previa (after 28 weeks' gestation) and pervious history of uterine CS scar/s with mean 2 (1-6) cesarean
deliveries were enrolled into the study, with mean age 30.08
± 7.01 years, gravidity 3.9 ± 1.1 and parity 2.4 ± 1.5. All
patients were evaluated with 2D, then color Doppler, Finally
3D and 3D power Doppler ,each US finding suggestive for
Morbidly Adherent Placenta (MAP) take a score; the cumulative score compared with the intraoperative final diagnosis.
The diagnostic accuracy was evaluated by receiver operating
characteristic (ROC) analysis.
Results: 2D had sensitivity (87.4%), specificity (92%),
PPV (97.6%) and NPV (65.7%) for diagnosis of Morbidly
Adherent Placenta (MAP), while color Doppler had sensitivity (94.7%), specificity (92%), PPV (97.8%) and NPV
(82.1%) , 3D power Doppler had sensitivity (93.7%) ,specificity (100%), PPV (100%) and NPV (80.6%) , finally 3D
section of the bladder interface had sensitivity (62.1%),
specificity (100%), PPV (100%) and NPV (41%). The diagnostic accuracy of the scoring system by using degree of
agreement (ROC curve) was (0.049) for 3D power Doppler, (0.049) for 2D US and (0.053) for color Doppler in
diagnosis of MAP. The area under the ROC curve was significantly equivalent to all tools of diagnosis (for 3D power
Doppler 1.000, 2D US 0.975, color Doppler 0.967 and for
overall scoring 0.979).
Conclusion: 3D power Doppler as an additional tool for diagnosis of MAP had the best
sensitivity(93.7%), specificity (100%), PPV
(100%) and NPV (80.6%) followed by color
Doppler with sensitivity (94.7%), specificity
(92%), PPV (97.8%) and NPV (82.1%) and
lastly 2D US with sensitivity (87.4%), specificity (92%), PPV (97.6%) and NPV (65.7%),
and the introduction of the scoring system
facilitates the diagnosis and differentiation
between MAP variants with scores (8-12 for
accreta, 13-18 for increta,19-25 for focal percreta and > 25 for diffuse percreta), so life
saving and fertility preservation procedures
could be probably planned