Serum Amyloid A as a Novel Marker of Morbidly Adherent Placenta

Abstract

Summary P lacenta accreta is a potentially life-threatening obstetric condition that requires a multidis¬ciplinary approach to management. The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar. Diagnosis of placenta accreta before delivery allows multidisciplinary planning in an attempt to mini¬mize potential maternal or neonatal morbidity and mortality. As the number of cases has increased, awareness of the possibilities and importance of antenatal diagnosis has resulted in more attempts to identify reliable diagnostic signs. Colour Doppler ultrasound, and particularly the use of three-dimensional colour Doppler, has made visualisation of vessels much easier. Assessment of uteroplacental neovascularization in placenta previaincreta/percreta may be important when investigating the severity of pathologic trophoblastic invasive behavior, and it is helpful for clinical decision making, guiding appropriate surgical timing and technique. The mainstay modality for screening for placenta accreta is the ultrasonography (US). Gray-scale US has been studied since late 1980s and early 1990s. Two-dimensional (2D) Power and Color Doppler were often used in conjunction with gray-scale US, though have not been shown to substantially increase its diagnostic accuracy. Over the last years, magnetic resonance imaging (MRI) has also been proposed as a diagnostic modality in screening for Placenta accreta, with quite promising results, despite its cost and unavailability in many centers. More recently, three-dimensional (3D) ultrasound and 3D Power Doppler (3DPD) have been introduced in the diagnosis and characterization of abnormal placentation