PREOPERATIVE MAGNETIC RESONANCE IMAGING COULD DEFINE WOMEN AT HIGH-RISK FOR CESAREAN HYSTERECTOMY SECONDARY TO PLACENTAL ADHESION DISORDER
Abdelhaseib Salah Saad & Yasmin Hosny Hemeda*
Departments of Obstetrics & Gynecology and Radiodiagnosis*, Faculty of Medicine, Menoufia University
Objectives: Evaluation of diagnostic validity of uterine ultrasonography (US) and MRI for verification of placental site and extent of invasion compared to surgical finding as a gold standard Patients & Methods: 96 multigravida women had previous 2-3 CS and 37 women had previous 1-3 curettage underwent abdominal uterine US and MRI for determination of placental site and adhesion. All women underwent elective CS and decision for hysterectomy was the last restore. Study outcomes included the accuracy of US and MRI for diagnosis of site and extent of placental invasion and the frequency of hysterectomy Results: Surgical uterine exploration detected the presence of adherent placenta in 17 patients (17.7%) and 11 had undertook cesarean hysterectomy (64.7%). Preoperative US and MRI can predict placental adherence by sensitivity and specificity rates of 76.47% and 88.61%, and 88.24% and 93.67%, respectively. Current study detected positive significant correlation between surgical findings on one side and results of preoperative US scanning and MRI, number of previous CS and curettage on the other side, but MRI findings showed the most significant correlation. ROC curve analysis assured these correlations and defined preoperative MRI as the most specific predictor for placental adherence. Conclusion: Abnormal placental adhesiveness is not uncommon disastrous condition that causes high frequency of cesarean hysterectomy. High numbers of previous cesarean section and/or curettage are high risk factors for development of abnormal placental site and adhesiveness. Preoperative uterine US scanning and MRI can define women with placentation abnormality with high sensitivity and specificity, but MRI is the ideal for its high specificity and can predict the need for hysterectomy.