Concordance of Grey Scale Findings of Morbidly Adherent Placenta with Intraoperative Findings

Objective: To evaluate the concordance between grey scale ultrasound findings and intraoperative observations in cases of morbidly adherent placenta (MAP) to assess the diagnostic accuracy of grey scale imaging in identifying varying degrees of placental adherence. Methodology: A prospective observational study was conducted at the Department of Obstetrics & Gynecology, PEMH Rawalpindi, from June 2023 to December 2023. Pregnant women aged >18 years, diagnosed with morbidly adherent placenta based on grey scale ultrasound findings, and scheduled for cesarean delivery were included. Intraoperative findings, particularly the extent of placental invasion into the myometrium and surrounding structures, stage of placental attachment, and involvement of the bladder or other organs, were recorded by the attending obstetrician/gynecologist during surgery. The findings were then compared with grey scale imaging results to evaluate diagnostic accuracy. Data was analyzed using SPSS version 26. Results: The mean age of the participants was 34.78 years, with 91.3% being housewives. Ultrasound findings indicated that Grade 2 placenta lacunae were commonly associated with cases without bladder invasion, whereas Grade 3 lacunae were strongly linked to bladder invasion. The uterine serosa-bladder interface showed no association with morbidly adherent placenta overall but was correlated with bladder invasion specifically. Placental thickness >4 cm was significantly associated with both bladder and broad ligament invasion. Grey scale parameters, including Grade 3 placenta lacunae (PPV: 91.67%), uterine serosa-bladder interface (PPV: 89.29%), and placental thickness >4 cm (PPV: 87.50%), demonstrated high positive predictive values for identifying true cases of morbidly adherent placenta. However, the sensitivity, specificity, and overall diagnostic accuracy of these parameters ranged from moderate to low. Conclusion: Grey scale ultrasound demonstrates a reliable positive predictive value for diagnosing morbidly adherent placenta, particularly through parameters such as Grade 3 placenta lacunae, uterine serosa-bladder interface, and placental thickness >4 cm. However, its moderate sensitivity, low specificity, and limited overall accuracy underscore the need for complementary diagnostic tools to enhance the accurate identification and management of MAP.