ABSTRACT

Objective:
To asses the value of adding three-dimensional (3D) power
Doppler (as a diagnostic technique) to grayscale and color Doppler techniques in the antenatal diagnosis of placenta accreta.

Methods:
One hundred pregnant women with persistent placenta previa
totalis (after 28 weeks’ gestation) were prospectively enrolled into this study.Gray-scale transabdominal ultrasound examination was performed to detect loss of the subendometrial echolucent zone and other abnormalities suggestive of placenta accreta. Color flow mapping was used to scan the whole placenta to detect any newly formed vessels at the serosa– bladder border or the presence of abnormal lacunae. Finally a targeted examination of angioarchitecture in the basal and lateral views of the placenta was carried out using 3D power Doppler. The ultrasound findings were analyzed with reference to the final diagnosis made during Cesarean delivery.

Results:
Placenta accreta and its variants (including increta and percreta)
were confirmed in 31 patients at the time of Cesarean delivery,
‘numerous coherent vessels’ visualized using 3D power Doppler in the basal view was the best single criterion for the diagnosis of placenta accreta, with a sensitivity of 96.8% and a specificity
of 91.3%.If we considered the presence of at least one criterion
to be diagnostic when using each ultrasound technique, then 3D power Doppler would have the best positive predictive value (75.6%), followed by gray-scale (60.4%) and color Doppler (57.1%). The majority of patients with placenta accreta showed multiple characteristic features on ultrasound imaging. In contrast, those patients with a false-positive diagnosis (i.e. the final diagnosis was placenta previa alone) tended to show isolated ultrasound markers of the condition.

Conclusion:
3D power Doppler may be useful as a complementary technique
for the antenatal diagnosis or exclusion of placenta accreta.