Prenatal Detection of Invasive Placentation on Colour Doppler Ultrasound in Patients with Previous Caesarean Delivery
OBJECTIVE: To determine the diagnostic accuracy of Color Doppler ultrasound in diagnosing invasive placentation/morbidly adherent placenta in patients with previous cesarean section keeping per-operative finding as gold standard.
STUDY DESIGN: It was a descriptive cross-sectional study conducted atDepartment of Diagnostic Radiology, Combined Military Hospital Lahore after the approval of synopsis from 04/10/2017 to 03/04/2018.
MATERIAL AND METHODS: This study involved 213 pregnant women aged between 20-40 years having history of at least 1 previous C-section presenting for antenatal scan after 28 weeks of gestation. Color Doppler ultrasound was performed to diagnose invasive placenta while the
diagnosis was confirmed later upon surgery which was taken as gold standard and results of color Doppler ultrasound were judged accordingly. Data was collected via study proforma and analyzed by SPSS version 20.
RESULTS: The mean age of the patients was 31.7±4.7 years while the mean gestational age at presentation was 32.2±2.1 weeks. The average of parity was 3.3±1.2 Out of all 61.5% women had 1, 28.6% women had 2 and 9.9% women had 3 previous C-section. Invasive placenta was labeled in 24.9% patients on color Doppler ultrasound while the diagnosis of invasive placentation was confirmed in 22.1% patients per operatively. It increased significantly with increasing number of previous C-sections; 1 vs. 2 vs. (p-<0.001). As per cross-tabulated the color Doppler ultrasound showed 87.23% sensitivity, 92.77% specificity and 91.55% accuracy in the diagnosis of invasive placenta with positive and negative predictive values of 77.36% and 96.25% respectively taking surgical findings as gold standard.
CONCLUSION: It was concluded that the morbidly adherent placenta increased with increasing number of previous C-sections and color Doppler ultrasound was found to be extremely sensitive and specific tool in its diagnosis which advocate its preferred use in future practice.
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