الفهرس 
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Abstract
Placenta previa and accretea are major causes of antepartum hemorrhage primary post partum and lead to increase number of morbidity and mortality in this study we focused on the morbidities which can occur as a result of placenta previa and accetra as regards to fertility pattern in these women.
This cases were followed up Women through 6 months after C.S. They would be subjected to the following interventions as, grey scale ultrasound of the uterus and ovaries and Doppler evaluation of the uterus and ovaries.
In the first visit which was after 3 month after C.S grey scale US of uterus, operas, Doppler evaluation of uterus operas was done. Office hysteroscopy for uterine cavity evaluation was done also.
Second visit was after 6 month after C.S. the women were subjected to the same previous interventions without repeating office hysteroscopy. 2 D grey scales US of frequency were used. Office hysteroscopy was done in the study group only.
TV probe was used after asking the patients for emptying their bladder. It was used to evaluate uterine volume, ovarian volumes, endometrial sickness measurement, uterine arteries diameters and uterine arteries Doppler five indices.
Ninety cases were recruited in the beginning of the study. After taking in consideration the inclusion and exclusion criterion, forty seven cases were followed up after 3 months of C.S. Two out of forty seven cases not pregnant. Twenty three women continued follow up. Five out of twenty three women got pregnant. Eighteen cases continued follow up at 6 month visit.
Control group of 50 women who had C.S operation for any cause and without any intraoperative hemorrhage or any additional surgical techniques performed during C.S. was compared. Doppler and Us characters’ findings were used.
As the personal characters there was a signifance in parity and abortion and BMI. Previous surgeries was significant in p-value of 0.001 which is also coped with the literature as previous surgeries increased the risk here most surgeries in form of C.S or Hyterotomies although in our study involved more women of no previous surgeries as their number was 30 and 17 who had previous surgeries but those had more parity and lastly educational level was significant in a P-value of 0.000. Other personal characters were not significant.
There was no significance Regards to obstetric history after 3 months and 6 months. Or surgical and obstetric data
As regards to 2D US it was significant for uterine volume (p value
0.005 and left ovarian volume (p value 0.047) when comparing the study and control group. The uterine artery diameter both right and left was significant P value of 0.000. We compared 2d US of the study group after 3 and 6 months there were no significance as regard to uterine volume right ovarian and left ovarian volume ,endometrial thickness and left and right uterine artery diameter.
As regard to sono hysterosalpinogram we found fluid in Douglas pouch in about 28 out of 47 cases in 59.6% and those who did not show fluid in Douglas pouch in 19 out of 47 in 40.4%.
As regard to color and pulsed Doppler of studied groups (after 3 month) and control groups we found significant P value in PI, PSV and TAMXV in both right and left sides.
TMAXV was only of significant be value when colored and pulsed Doppler in the studied group after 3 and 6 month were compared.
2 out of 47 cases of the follow up got pregnant after 3 months postpartum by asking them by telephone and confirmed positive pregnancy tests. And by 6 months postpartum 5 women got pregnant. 3 of the 7 cases we could follow up by telephone and they got delivered at GA of 38 w by elective C.S with no recurrence of p placenta previa or accrete and no post-operative complications and for luck one of those we followed up at 3month and we found moderate adhesions in office hysteroscopy and followed her by telephone by asking on her menstrual pattern which was irregular at first for 2 months and regulated by hormonal treatment after which she got pregnant and was followed up for recurrence of placenta previa or accrete but her placenta was normal situated and underwent an elective C.S at 38 weeks with no postoperative or intraoperative complications. And she was the only case in whom the office hysteroscopy was significant.
That result may not satisfy with the revascularization assumption). May be if longer follow up was done. It could reveal that conflict and leads us to more results. No previous studies on the Doppler finding after conservative management of placenta previa or accrerta.
The present study is unique in trying to prove if the conservative measures could lead to a stigma that can delay the chances of pregnancy by using hysterosapinogram and US Doppler to know which is best to be applied in the management of placenta previa or accetea to improve out comes.