Netrin-1 and Placenta Accreta

Netrin-1 is a secreted protein, which was first identified as a neuronal guidance factor. It is expressed in a multitude of tissues as pancreas, lung, breast, and placenta. Netrin-1 is a multifunctional protein, involved in cell polarity, adhesion, angiogenesis, apoptosis, migration, morphogenesis, and differentiation of various cell types. Most of netrin-1 activity occur through signaling pathways induced by its two main receptors, DCC (deleted in colorectal cancer) and UNC5H (uncoordinated-5 homolog). Its receptors have been linked to the processes of apoptosis and angiogenesis. In absence of netrin-1, DCC and UNC5H receptors lead to apoptosis. In contrary, in presence of netrin-1, receptors transduce molecular cascades leading to proliferation, differentiation and migration of the cells. Netrin-1 has been involved in the pathogenesis of multiple diseases, as diabetes, cardiovascular diseases, and cancer. Serum Netrin-1 levels were high in preeclamptic patients.

Inclusion Criteria: Age between 20-40 years. Singleton pregnancy. Women with suspicion of PA by two-dimensional (2D) gray scale imaging and color Doppler flow mapping Exclusion Criteria: Multiple pregnancy, Fetal anomalies, Preterm premature rupture of membranes, or infection Any medical disorders, such as thyroid dysfunction, hypertension, and gestational diabetes Patients with known bleeding disorders or on anticoagulant therapy.