The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders

Hussein, Ahmed M.; Momtaz, M.; El-Sheikhah, Ahmad; Abdelbar, Ahmed

doi:10.1007/s00404-020-05707-y

Cited by 15 publications

(20 citation statements)

References 23 publications

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“…Massive bleeding is one of the most common problems in the management of PAS whether the patient is having conservative surgery or a cesarean hysterectomy [19,31,32]. The average blood loss during PAS surgery has been reported as varying between 2000 and 5000 mL, levels which require in turn massive blood transfusion [13,16,33,34]. PAS also involves increased rates of organ injuries and ICU admissions and longer hospital stays, as found in our study and other studies [11,13,35,36].…”

Section: Discussionsupporting

confidence: 78%

“…Our study was done in the main tertiary referral center for managing PAS in the south of Thailand, where the incidence of PAS has been increasing for several years now and recently reported the very high rate of 1:161 deliveries [10]. The average blood loss in PAS during the study period was 2500 mL, which is in the same range as other studies [34][35][36][37]. In our study, most of the PAS cases underwent a cesarean hysterectomy (94%)…”

Section: Discussionsupporting

confidence: 70%

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Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

2022

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Objective To evaluate certain two-dimensional (2D) ultrasound signs as predictors of massive peri-operative blood loss (PBL) in pregnant women with placenta previa suspicious of PAS disorder. Materials and methods A single center retrospective study was done in pregnant women who had undergone prenatal diagnosis with 2D ultrasound grey scale and color Doppler using the EW-AIP (which has been changed to IS-PAS (International Society for the Placenta Accreta Spectrum)) criteria between January 2007 and May 2021. The patients were divided into 2 groups, non-massive hemorrhage with PBL ≤ 2500 mL and massive PBL >2500 mL. All PAS cases had pathological confirmation. Ultrasound signs and hemorrhagic outcomes were compared between the two groups. A PAS scoring system to predict massive PBL was constructed and a receiver operating characteristic (ROC) curve was calculated to evaluate the efficacy of the scoring system. Results Of 534 women, 146 (28.3%) had PBL > 2500 mL and 388 (71.7%) had PBL ≤ 2500 mL. In the massive PBL group, 101 (69.2%) were diagnosed as PAS and 45 (30.8%) as placenta previa alone. From 10 evaluated 2D ultrasound signs, 3 had the highest odds ratios (ORs) associated with massive PBL, ‘focal exophytic mass’ OR 8.17 (p = 0.024), ‘placental bulge’ OR 2.47 (p = 0.011), and ‘placental lacunae feeder vessels’ OR 2.38 (p = 0.01). When using the PAS scoring system, the AUC to predict massive PBL was 0.80 (95% CI, 0.76–0.85,). Conclusion Our PAS scoring system based on 2-dimensional ultrasound signs combined with grey scale and color Doppler is useful to predict massive PBL and can help optimize pre-operative management in cases of previa suspicious of PAS.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionsupporting

confidence: 70%

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

2022

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“…ough, it was in dilatation and curettage cases [22]. Our results are consistent with another study, which found that intraoperative bleeding was moderately associated with PAS, which could be predicted using 2D and 3D color Doppler [23]. Vascular quantification assessment using 3D Doppler ultrasound proved to be a diagnostic adjunct to identify the possibility of bleeding ≥ 1500 cc.…”

Section: Discussionsupporting

confidence: 89%

Relationship of Placental Vascular Indices with Macroscopic, Histopathologic, and Intraoperative Blood Loss in Placenta Accreta Spectrum Disorders

Dilmy

Purwosunu

Saroyo

et al. 2022

Obstetrics and Gynecology International

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Introduction. Placenta accreta spectrum is an obstetrical complication with a high level of morbidity. The 3-dimensional (3D) power Doppler method has been widely used to improve the diagnosis. Therefore, this study aims to elucidate better the relationship of quantitative placental vascular indices towards macroscopic findings, histopathological grading, and intraoperative blood loss in the disorder. Methods. A preliminary study using a cross-sectional design was conducted on 34 clinically diagnosed women with PAS. The 3D power Doppler with the VOCAL II software was used to measure the level of vascularization index (VI), flow index (FI), and vascularization flow index (VFI). Gross anatomical appearance and histopathology results were categorized as accreta, increta, and percreta. In addition, the intraoperative blood loss level was measured, and 1500 mL was the cutoff for massive hemorrhage. Results. The vascularity indexes were VI = 44.2 (23.7–74.9), FI = 35.4 (24.9–57), and VFI = 15.3 (8.5–41.7). The FI value was significant in comparing gross pathological stages ( p = 0.015 ) and had a moderate positive correlation in relation to blood loss (r = 0.449). VI, FI, and VFI above the cutoff values were shown to be strongly associated with blood loss ≥ 1500 cc with aOR 7.00 (95% CI 1.23–39.56), aOR 10.00 (95% CI 1.58–63.09), and aOR 9.16 (95% CI 1.53–54.59), respectively. Conclusion. This preliminary study demonstrated an initial potential of the FI value from 3D USG power Doppler to predict the depth of PAS invasion before surgery and intraoperative blood loss level.

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“…Hussein et al (20) stated that regarding 2D color Doppler can increase the accuracy of prediction of massive hemorrhage in cases of PAS disorders and only the presence of numerous coherent vessels involving the bladder-serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy which is due to different inclusion and exclusion criteria than current study. Also, Shi et al (16) , Japaraj et al (18) studies found that the most prominent color Doppler diagnostic sign was the presence of abnormal vessels connecting the placenta to the bladder which is due to different methodology than current study.…”

Section: Resultsmentioning

confidence: 49%

Accuracy of Multi-Slice 3d-Doppler in Diagnosis of Morbidly Adherent Placenta in Comparison With 2d-Doppler

Khalil

Abdelrahman

Farag

et al. 2021

Ain Shams Medical Journal

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The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders

Cited by 15 publications

References 23 publications

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

Two-dimensional ultrasound signs as predictive markers of massive peri-operative blood loss in placenta previa suspicious for placenta accreta spectrum (PAS) disorder

Relationship of Placental Vascular Indices with Macroscopic, Histopathologic, and Intraoperative Blood Loss in Placenta Accreta Spectrum Disorders

Accuracy of Multi-Slice 3d-Doppler in Diagnosis of Morbidly Adherent Placenta in Comparison With 2d-Doppler

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