Color Power Doppler Ultrasound Case Study

THREE DIMENSIONAL COLOUR POWER DOPPLER ULTRASOUND

The role of three-dimensional color power Doppler is better established. Color power Doppler ultrasound is reported the most sensitive and specific single criterion (sensitivity 97% and specificity 92%), with the highest positive predictive value currently reported for diagnosis. This is the single most reliable diagnostic modality and it increases diagnostic confidence in determining the exact site, depth and extent of invasion. Characteristic findings on three dimensional color power Doppler ultrasound include:

(1) Numerous dilated and coherent vessels involving the serosa–bladder interface on a basal view;

(2) Increased intraplacental hypervascularity on a lateral view.

(3) Inseparable

The care of women diagnosed at any stage of pregnancy with MAP should be conducted by obstetricians working as part of a multidisciplinary team.Two senior obstetricians specialized in fetomaternal medicine supervise the care of women with a diagnosis of MAP. This ensures that routine pregnancy assessments and care are not ignored as a result of the overriding concerns about the risks of placental bleeding. PLANNED MANAGEMENT IN ANTENATALLY DIAGNOSED CASES After the antenatal diagnosis of MAP, a multidisciplinary team should be assembled. Ideally the team should include specialist obstetricians, anesthetists, urologists, interventional radiologists, hematologists, neonatologists, blood transfusion specialists, operating department practitioners, portering staff and theater nurses and assistants trained to assist in performance of cesarean hysterectomy and laparotomy, along with a full complement of gynecological, vascular surgery and urology instruments.In reality, this list needs to be modified to comply with local needs, requirements and

It also has to be decided whether a total or subtotal (supracervical) hysterectomy is more appropriate. A subtotal hysterectomy is more expedient particularly in moribund cases, but a total hysterectomy with removal of the cervix is advocated by some surgeons because of concerns about delayed hemorrhage from the hypervascularized vault especially in cases of placenta previa accreta. In practice, the decision is often best taken intraoperatively based on the patient’s physical condition, the degree of distortion of the pelvic anatomy by placental infiltration or scarring from previous surgery and the severity of bleeding. Surgical skill and experience significantly influence the decisions because of the distorted anatomy that often accompanies morbid placental adherence, and situations may arise where a subtotal operation is preferred because of the woman’s clinical status, or limited operator