Creatine Kinase Versus 3D Doppler for Antenatal Diagnosis of Abnormal Adherent Placenta.

Study Overview
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Brief Summary
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Placenta accreta is a potentially life-threatening obstetric condition that requires a multidisciplinary approach to management.Diagnosis of placenta accreta before delivery minimizes potential maternal or neonatal morbidity and mortality. In this study the researchers will evaluate the role and cost effectiveness of biochemical marker as creatine kinase in comparison with 3D Doppler ultrasound in antenatal diagnosis of placenta accreta and its variants in patients with placenta previa totalis.

Detailed Description
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Abnormal placentation poses a diagnostic and treatment challenge for all providers caring for pregnant women. As one of the leading causes of postpartum hemorrhage, abnormal placentation involves the attachment of placental villi directly to the myometrium with potentially deeper invasion into the uterine wall or surrounding organs. Surgical procedures that disrupt the integrity of uterus, including cesarean section, dilatation and curettage, and myomectomy, have been implicated as key risk factors for placenta accreta(Megier et al., 2000).Prenatal diagnoses of placenta accreta through the use of gray-scale ultrasonography, color Doppler imaging, and magnetic resonance imaging have been reported previously (Chou et al., 1997). Placenta increta and percreta have rarely been diagnosed antepartum, and ultrasonographic findings may provide the only objective evidence of placenta accreta.A biochemical marker for this condition would therefore be useful (Ophir et al., 1999).It is critical to make the diagnosis before delivery because preoperative planning can significantly decrease blood loss and avoid substantial morbidity associated with placenta accreta (Shih et al., 2009).

Official Title
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Creatine Kinase Versus 3D Doppler for Antenatal Diagnosis of Morbidly Adherent Placenta

Conditions
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Placenta Accreta

Intervention / Treatment
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* Diagnostic Test: maternal serum creatine kinase
* Diagnostic Test: 3D Doppler ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - a- Pregnant lady with history of previous cesarean section or hysterotomy. b- Placenta previa with its lower edge covering the scar of previous cesarean section as diagnosed by 2DU/S. c- Gestational age ranging from 28 wks - Full term. Exclusion Criteria: Women with one or more of the following conditions contributing to rhabdomyolysis: Crush injury and prolonged surgery. Embolism, thrombosis, D.V.T., myocardial or brain infarction. Drug overdose: Antipsychotics, antidepressants, hypnotics, narcotics, alcohol, halothane,salicylates. Excessive muscle activity as epileptic fit. Chronic hypertension & PIH Endocrine disorders: hyper-/hypothyroidism, and diabetes mellitus,history of liver disease or renal disease.

Ages Eligible for Study
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Minimum Age: 25 Years
Maximum Age: 35 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: maternal serum creatine kinase|Biochemical marker|
|Diagnostic Test: 3D Doppler ultrasound|Doppler for placental vessels|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| maternal morbidity | Antepartum and Postpartum maternal complications of morbidly adherent placenta. | from 28 weeks gestation until 24 hours postpartum. |