Role of Doppler imaging in diagnosis of placenta accreta in women with placenta previa and prior Caesarean Section

Maternal and fetal morbidity and mortality from placenta previa are considerable and are associated with high demands on health resources with the rising incidence of cesarean sections combind with increasing maternal age,the number of cases of placenta previa and its complications will continue to increase.Placenta accreta is defined as the condition where placenta is firmly adherent to the underlying uterine wall in part or in total. The commonest condition associated with it are placenta previa and previous caeserean section. It is said that with placenta previa, the incidence approaches 10% but in the presence of previous caeserean section and placenta previa, the incidence goes up to 25%.Placenta accreta is one of the most dreaded complication of pregnancy with significant maternal morbidity and mortality due to severe haemorrhage, uterine perforation and infection. The incidence varies from 1:2500 to 1:7000 deliveries in recent years. According to clark et al., 25%, of patient with placenta previa and one previous caesarean section. and at least 50% of patients with two or more caesarean sections developed placenta accreta and 82% required caeserean hysterectomy. For this reason, one must be very careful while managing cases complicated by placenta previa in previous. caeserean Section right from making the diagnosis so as to make best possible preoperative arrangemen.