Determination of Placenta-Myometrium Relationship in Caesarian Sections

INTRODUCTION: The relative prevalence of placental attachment abnormalities (PAA) has been increased lately. They may cause severe complications in respect to their types, and determining presence and the type of the invasion before delivery is important for the obstetrician.
The objective of this prospective, cross – sectional and descriptive study was to investigate PAA preoperatively using gray scale and Doppler ultrasonography (USG) in patients who had a Caesarian section (C/S) at least once before and scheduled for C/S again, and to compare the results with histopathological diagnosis.
METHODS: A total of 104 pregnant women who admitted to Yıldırım Beyazıt University Medical Faculty, Atatürk Education and Research Hospital Obstetrics and Gynecology Department between January and July 2013, and scheduled for C/S were included in the
study. All of the included patients had had C/S before, at least once. Gray scale and Doppler USG was performed in all patients to determine PAA, and the findings were compared with the histopathologic results of placental bed biopsy obtained during C/S.
RESULTS: The indications for C/S were previous C/S once in 74%, previous C/S twice in 25.5%, and previous C/S more than twice in 1% of the patients. None of the patients had any suspicion for PAA intraoperatively, postoperative complications, or PAA in the histopathological
diagnosis. There were no findings on Doppler USG in 77.9% of the patients, 20.2% of them had increased vascularity alone, 1.0% had increased vascularity and lacunar flow, and 1.0% had lacunar flow alone in the subplasental region. There were no findings on gray scale USG in 90.4% of the patients. There were placental lacunae and obliteration of the retroplacental clear zone in 2.0% of the patients, and the thinnest myometrial wall was <1 mm in the placental region in 7.6% of them.
DISCUSSION AND CONCLUSION: Absence of PAA in our series may be due to factors such as our surgical technique, and individual wound healing processes. The mechanisms causing abnormal placentation are not still clear.