Value of measurement of maternal serum alpha fetoprotien in diagnosis of pathologically adherent placenta in cases of placenta pravia

Objective: to investigate the significance of elevated MSAFP in diagnosing pathologically adherent placenta among women with placenta previa and its predictive value for pregnancy outcome. Study Design: A retrospective study involved eighty women with placenta praevia divided into 4 equal groups according the degree of invasion as suspected by TAS, Doppler and MRI studies and confirmed postoperatively by histo-pathological examination. G1; included those with placenta pravia alone G2; those with placenta accreta, G3; those with increta degree while G4 contained those with placenta percreta. MSAFP level were evaluated for all patients between 34-36 weeks gestational age. Results: Baseline characteristics of the study group showed no significant difference among groups 1, 2, 3 as regard maternal age, gravidity, parity, fetal gestational age and body mass index (p>0.05) but when compared separately with group 4, there was significant increased mean (+SD) (P <0.05) but not in the body mass index. Maternal risk factors of placenta praevia and abnormal placental adherence proved more previous uterine scars in groups 3 and 4, (P < 0.002). MSAFP levels represented a remarkable increase in groups 2 and 3 and shooting up in group 4 (mean+SD, 91.3+19.1, 153.2+38.1, 178.3+25.2, 263.3+36.1 respectively, P value 0.001). Fetal and maternal outcomes as well as intraoperative findings showed some statistical significant differences between the studied groups as maternal intraoperative blood loss was found more evident in G4 (mean + SD 931± 312) compared to G1, 2 and 3 (640 ± 191, 767 ± 331, 834± 284; respectively, P value 0.02) with more liability for postpartum hemorrhage, 7 cases (35%) versus 0, 2 and 3 cases in G1, 2, 3. respectively (P 0.003). IIAL was resorted to in 7 cases in G4 compared to nothing in G1 and G2 while in 2 cases only in G3. Bladder injuries were reported in 5 cases in G4 and 1 case in G3 but not in G1 and 2 (P 0.002). The mean operative time in minutes (SD) was found relatively shorter in G1 but longer in G2 and 3 but longest in G4 (34 ± 9.1, 44 ± 5.1, 49 ± 9.2, 55 ± 8.1, respectively, P value 0.01). There were more need for intra and postoperative blood transfusion in cases of G4, 7 cases versus 2 cases only in G2 and 3. Again, there was more requested emergent caesarean hysterectomy in G4 (4 cases versus one case in G3, P 0.01). The postoperative data confirmed that there was evident longer duration of hospital stay in G4 (5 +2.3) compared to other groups 1, 2 and 3 (3.2 + 1.1, 3+ 1.2, 3.5+1.3, P value 0.01). Admission to intensive care unit was recorded higher in G4, 5 cases compared to 1 case only in G3 (P 0.002). No maternal mortality recorded as well as neonatal intensive care unit admission.ROC analyses finds elevated MSAFP stated the maximum sum of sensitivity and specificity for the significant test and showed the AUC was 0.752 (95% CI: 0.505–0.979)with 83.54% sensitivity and 71.53% specificity (p = 0.042). Conclusion: Increased third trimester MSAFP levels can predict morbidly adherent placenta in placenta previa patients, with no other obvious cause, as well as intraoperative complications.