Placental adhesions diagnosis in the first trimester of pregnancy by using three-dimensional (3D) ultrasound and color Doppler

Abstract Background Early identification of placenta accreta, especially in women with a previously scarred uterus, is crucial, and advanced imaging techniques, such as two-dimensional (2D), three-dimensional (3D) ultrasound (US), and color Doppler, were used for early prediction and reducing maternal risks. Aim The study aims to assess the effectiveness of 3D US and color Doppler in identifying placenta accreta spectrum (PAS) during early pregnancy among women with a history of uterine scarring compared to ultrasound findings in later trimesters. Methods A prospective study involved 256 first-trimester pregnant women, randomly selected from the antenatal outpatient clinic et al.-Zahraa University Hospital. The data were collected through present and past history, physical examination, and investigation. 3D and color Doppler ultrasound was done in early pregnancy; they were followed up to 28 weeks of pregnancy to compare the findings. Results Among the studied pregnant women, 1.5% exhibited low-lying gestational sac implantation, and 3.9% showed increased blood flow as detected by color Doppler. The percentage of abnormal placental positions in the ultrasound was 8.6% in the first trimester, 4.7% in the second trimester, and 7.8% in the third trimester. Regarding ultrasound findings of PAS, there was substantial agreement between the first and second trimesters (Kappa = 0.687, p < 0.001) and between the first and third trimesters (Kappa = 0.741, p < 0.001). Furthermore, ultrasound finding of PAS was found to be significantly associated with several maternal factors, including advanced maternal age, higher parity, an increased number of previous cesarean deliveries, a history of abortion, and threatened abortion during the current pregnancy. Conclusion 3D ultrasound combined with Doppler imaging demonstrated substantial agreement across trimesters for identifying features suggestive of PAS which suggests potential utility for early risk stratification. Advanced maternal age, high parity, and multiple previous cesarean deliveries emerged as key maternal risk factors.