Placenta accreta: Is there a place for over sewing of placental site?

Placenta accreta is a cause of life threatening hemorrhage. Hysterectomy is the traditional treatment. Over sewing placental site were introduced to preserve fertility but its place is not clear. 25 patients with placenta accreta had been treated, during period of 12 month, in Medical City. Over sewing of the placental site were tried in ten cases. Six women out of ten preserve their reproductive function with over sewing sutures. Over sewing of placental site showed some effect in some patients who had focal placenta accreta

value of color doppler ultrasonography in prediction of ovulation during the normal menstrual cycle

To evaluate transvaginal color Doppler ultrasonography [U/S] as a tool to predict ovulation during the normal menstrual cycle through the measurement of blood flow changes in ovarian and uterine blood vessels. A prospective study was conducted on 30 women attending an infertility clinic at Baghdad Teaching Hospital. All the woman had infertility not attributed to ovulation and had regular menstrual cycles. Transvaginal color Doppler U/S scan was performed on each women daily form day 10 of the menstrual cycle until ovulation. Each woman underwent 4-5 vaginal U/S examinations. To confirm reported ovulation, serum progesterone level was estimated 6-7 days after the expected date of ovulation. Signs of ovulation were demonstrated by U/S in 23 of 30 the women. The mean diameter of the dominant follicle [DF] one day before ovulation was [20.26 mm +/- 2.09] with an average growth rate of 2.2mm/day. The mean serum progesterone level 6-7 days after ovulation was 19.12 +/- 5.24ng/mL. Ovarian and uterine blood flow, assessed by pulsed color Doppler U/S indices, showed a marked increase particularly around the time of ovulation, whereby mean resistive index [RI] of the ovary having the DF was 0.56 +/- 0.03 four days before ovulation, and it reached its nadir one day before ovulation [0.47 +/- 0.02] [P<0.0001]. A similar change was observed in the ipsilateral uterine artery, as a consequence of the follicular growth and subsequent corpus luteum formation. The mean RI was 0.86 +/- 0.05 four days before ovulation and 0.85 +/- 0.04 on the day of ovulation [P<0.05], while its mean pulsatility index [PI] was 2.97 +/- 0.063 four days before ovulation and became 2.59 +/- 0.59 on the day of ovulation [P<0.05]. Assessment of ovarian and uterine vascularity by pulsed color Doppler U/S has a potential value in prediction of ovulation and may be used as a parameter in infertility practice