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

Alaa M. Abdel Moniem, Khaled M. Abdelrazak, M. Hussain, Ahmed M. Awadalla and Ibrahim A. Abdelazim*

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

Placenta accreta occurs when placental trophoblasts invade endometrium beyond the Nitabuch’s layer of decidua basalis, while placenta increta occurs when placental trophoblasts invade myometrium and placenta percreta occurs when trophoblasts invade serosa.

MAP (morbid adherent placenta) is usually associated with excess blood loss, bladder injuries and hysterectomies.
Incidence of MAP has increased significantly over the past 50 years.

Previous cesarean delivery, placenta previa and damage of Nitabuch’s layer of decidua basalis following intrauterine
infection or scarring are risk factors of MAP.1,7-9 Incidence of MAP is increased concomitantly with increased cesarean section rates.

Incidence of MAP is 3.3% in pregnant women with no
prior cesarean delivery and placenta previa and is 40% in pregnant women
with previous two cesarean sections and placenta previa.

If MAP was diagnosed or suspected before delivery,
the optimum time for planned delivery is around 34-35 weeks
following a course of corticosteroid and multidisciplinary care team approach

Accurate diagnosis of MAP is essential to prepare both 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
and MRI should be reserved for cases with inconclusive sonographic findings.

In 1903, Demons described resolution of symptoms with ovarian tumor resection, and in 1937, Meigs and Cass described, in seven patients, the classical triad of pleural effusion, ascites, and ovarian tumor; in 1954, these authors described the syndrome, which consists of fibromas with ascites and hydrothorax,
characterizing later resolution on removing the benign tumor.

Gynecol Obstet Res Open J. 2015; 2(3): 62-68. doi: 10.17140/GOROJ-2-114