Evaluation of the diagnostic accuracy of designed ultrasound- based scoring system for prenatal diagnosis and differentiation of Morbidly Adherent Placenta (MAP). | ||||
| The Egyptian Journal of Fertility of Sterility | ||||
| Article 6, Volume 26, Issue 1 - Serial Number 11106352, January 2022, Page 54-72 PDF (3.64 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2022.216266 | ||||
 View on SCiNiTO | ||||
| Author | ||||
| Yaser Abd El-dayem | ||||
| professor of obs&gyn, Faculty of medicine ,Mansoura university,Mansoura,Egypt | ||||
| Abstract | ||||
| 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 | ||||
| Keywords | ||||
| placenta; ultrasound; scoring; morbidly | ||||
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