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Placenta accreta occurs when there is an abnormal adherence of a part or entire of the placenta to the uterine wall with either partial or complete absence of the decidua basalis. The placenta may be abnormally adherent to the myometrium, or extend to invade other tissues (uterine serosa or urinary bladder). One of the catastrophic complications of PA is massive hemorrhage at the time of placental separation which can lead to renal failure, adult respiratory distress syndrome, and even death. In severe cases hysterectomy may be required, also urinary buy Oxamflatin or ureteral injury, pulmonary embolism are other serious complications. Incidence of placenta accreta is markedly increased with the number of previous cesarean sections, the risk of placenta accreta increased with woman who had one cesarean section than with those with an unscarred uterus about 8 folds and then increased 4-fold with woman who had 2 or more cesarean sections.
Multiple sonographic findings are seen with placenta accrete such as decrease in myometrial thickness, placenta previa, placental lacunae, abnormal pattern of color Doppler, loss of the retroplacental clear zone and placenta percreta irregularities in wall of UB have been detected. MR imaging is used in the diagnosis of placenta accreta when the sonographic findings are equivocal or when the placenta has a posterior location. Many advantages are found for using MRI included excellent soft tissue contrast and non ionizing radiation in comparison with some limitations such as high cost, claustrophobia and limited availability. The most MRI characteristic findings seen in placenta accrete are nodular thickening in the dark zone of placenta–uterine interface together with extensions of dark bands through the placenta, outer uterine bulge causing from the mass effect of the placenta and heterogeneous signal intensity of placenta on the T2-weighted HASTE sequences due to large placental lakes and vessels. In spite of many studies having suggested the diagnostic accuracy of MRI in placenta accreta, some studies suggest that MRI is no more sensitive than ultrasound in the diagnosis of placenta accreta The use of intravenous contrast enhancement (e.g. gadolinium) increases the specificity of MRI in the diagnosis of placenta accreta. Some still reluctant to use gadolinium because it crosses the placenta and is found in fetal tissues. However there are no reports of any side effects in human fetuses.
Patients and methods
The patients included in the study were:
The mean age among this study group was 29years ranging from 20 to 40. While among patients with confirmed placenta accreta, the mean age was 32.25 ranging from 25 to 40years. The mean parity of patients ranged from 1 to 6 with a mean of 1.6. Among patients with placenta accreta, the mean parity ranged from 2 to 6 with a mean of 3.75. The mean number of CS among the study group was 1.6 ranging from 1 to 5. The mean number of CS among patients confirmed to have placenta accreta: 2.75 ranged from 2 to 5.
Half of the cases with placenta accreta have 4 or 5 prior cesarean deliveries. No cases of placenta accreta were diagnosed among the 70 cases with prior 1 CS. So we found that the number of accreta cases increases in patients with increased number of previous CS. (Table 1).
The total number of cases with placenta accreta in this study was 4, all of which were previa. This was out of a total of 25 cases of placenta previa. Placenta previa was classified into four grades, Grade I: low-lying placenta Grade II: marginal anterior, Grade III: partial placenta previa centralis and Grade IV: total placenta previa centralis. Placenta accrete was found in one case with partial placenta previa centralis and in three cases with total placenta previa centralis not found in placenta low lying or in placenta previa marginalis (Table 2).
Placenta accreta is relatively rare but it is one of the life-threatening complications for pregnancy due to massive obstetric hemorrhage. The incidence of placenta previa and placenta accreta was increased as regards to increase in the rate of cesarean sections.
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