الفهرس 
PlacentaPreviaOnly 14 pages are availabe for public view
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Abstract
lacenta previa exists when the placenta is inserted wholly or in part into the lower segment of the uterus (RCOG: Green-top Guideline No.27., 2011).
The type of sonography used for detection of placenta previa is transabdominal, transvaginal and transperineal (Rani et al., 2007).
The aim of this work was to determine the accuracy of transperineal ultrasound versus transvaginal ultrasound in the diagnosis of placenta previa in late pregnancy.
And our Research Question was
Does transperineal sonography have a comparable diagnostic accuracy in women with placenta previa in the third trimester of pregnancy?
We conducted a prospective comparative study at Ain Shams University Maternity Hospital at Ultrasound special care unit for the fetus using Medison sonoace R5 ultrasound machine with 7.9 MHz transvaginal probe for transvaginal scanning and 3.5 MHz transabdominal probe for transperineal scanning. 67 cases suspected to have placenta previa by trans-abdominal US were enrolled. In this analysis, the comparison between transperineal versus transvaginal US for having placenta previa diagnosis judged by intraoperative visualization.
The patients were recruited from Ain Shams University Maternity Hospital from the casuality and the antenatal care clinic with placenta previa (major or minor) during the third trimester which is diagnosed by 3rd trimesteric abdominal ultrasound.
Our study population had gestational age >20 weeks, absence of labor pains, absence of active vaginal bleeding and vital data were stable.
After taking informed oral consent, the recruited patients were subjected to history taking, accurate estimation of gestational age, general examination, abdominal examination and the patients who were assumed having placenta previa (major or minor) by late pregnancy abdominal ultrasound were subjected to both transvaginal ultrasound and transperineal ultrasound by two different well trained sonographers and each sonographer was blind to the other sonographer’s ultrasound report, then confirmation of placental site was done intraoperatively during cesarean section.
The ultrasound scans was repeated at least 2 weeks before delivery to exclude placental migration for the patients with conservative management.
Our gold standard finding was detection and recording of placental localization at time of delivery to compare it with the results obtained from both groups. Our cohort also were subjected to pain and discomfort assessment that may experience during the ultrasound scan and this was done using “Verbal Descriptor Scale”.
There was significant moderate agreement between intraoperative observation (golden test) and both transperineal ultrasound and tranvaginal ultrasound. The diagnostic accuracy was 92.5% (90.4% –93.1%) for tranperineal versus 97.0% (96.1%–97.3% CI) for the transvaginal.
In our study, the “Verbal Descriptor Scale” assessment was significantly higher in transvaginal than in transperineal US (mean 3.3±0.4, 1.3±0.4 respectively, p value <0.001).
Conclusion:
Both TPS& TVS are valuable techniques to complement TAS for the diagnosis of placenta previa. However, TPS showed to have advantages over TVS because of less discomfort, no need for specialized equipment, and avoidance of vaginal penetration especially in cases where risk of infection is present e.g. premature rupture of fetal membranes.
In conclusion; being a safe, rapid, & accurate technique with little patient discomfort; TPS is a valuable approach for evaluating these high risk group of patients with PP with a better patient acceptability though further studies are needed to validate our results.