Role of Three-Dimensional Multi-Slice Color Flow Doppler in Diagnosis of Morbid Adherent Placenta

Abstract

Background: The most common causes of morbid adherent placenta (MAP) include hysterectomies, excessive blood loss, and bladder  injuries. Placental trophoblasts that penetrate the endometrium past the Nitabuch layer of decidua basalis cause placenta accreta, while  placental trophoblasts that penetrate the myometrium cause placenta increta.

Objectives: To evaluate the role of the multislice 3D color  flow Doppler in the diagnosis of MAP in relation to intrapartum findings and the mean value of placental volume vascularization index  (VI) and flow index (FI) and vascularization flow index (VFI).

Patients and Methods: This was a prospective study that included 41  pregnant women at Department of Obstetrics and Gynecology in Menoufia University Hospital, from December 2021 till March 2023.  

Results: Cutoff point of placental (VI) as a marker in prediction of placental invasion among cases was 23.760, with sensitivity of 94.1%,  specificity of 95.8% at AUC of 0.771. Cutoff point of placenta (FI) as a marker in prediction of placental invasion among cases was 32.405,  with sensitivity of 88.2%, specificity of 83.3% at AUC of 0.513. Cutoff point of placental (VFI) as a marker in prediction of placental invasion  among cases was 9.305, with sensitivity of 94.1%, specificity of 95.8% at AUC of 0.749.

Conclusion: among the 3D color flow Doppler  indices, VI had the best index in prediction of placental invasion, followed by VFI while FI had the lowest. Additionally, loss of sonolucency  was the most 3D multislice color flow Doppler in the diagnosis of MAP with accuracy 92.3%, followed by placental lacunae with accuracy  84.5%, then abnormal uterine serosa bladder line by 80.55% of accuracy.