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

Abstract

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.

The Role of Ultrasound in Prediction of Intraoperative Blood Loss in Cases of Placenta Accreta Spectrum Disorders

“…Moreover, the median number of parities was 5 in the minor group and 6 in the major group with a significant difference between the two groups [p-value= 0.007]. This comes in agreement with Watthanasathitnukun et al [8] , where a significant difference was found [p-value <.001]. However, Zhou et al [9] did not find a significant difference.…”

“…However, the mean gestational age did not have a significant difference between the two groups [p-value= 0.6]. This comes in contrast with previous reports where a significant difference was found [7][8] . This may be attributed to different geographical area and inclusion criteria of the mentioned studies.…”

“…The minor group had a mean of 10.9±3.7, while the major group had a mean of 16.9±3.9, with a significant difference between the two groups. Also, Watthanasathitnukun et al [8] found a significant difference between the two groups.…”

“…This comes in agreement with the previous done study by Cali et al [7] who also found a significant difference between the two groups regarding the number of parities. However, Watthanasathitnukun et al [8] did not find a significant difference between the two groups [p-value= 0.874]. This similarity may be attributed to the fact that previous CS is one of the major risk factors for placenta accrete.…”

Prophylactic uterine artery embolization during cesarean delivery for management of hemorrhage in complete placenta previa: An observational study

“…In this study we included only patients with complete placenta previa defined as: placenta previa completely covering cervical OS. All patients with complete placenta previa was evaluated by Ultrasound Scoring System before operation, and ultrasound score ≥ 6 points was identified as suspicious placenta accreta spectrum (PAS) disorder as previous published article, [15][16][17] and patients with suspicious PAS disorder were excluded from the study. All patients in this study were well planned and prepared before operation, elective cesarean section was scheduled between 36 and 38 weeks according to Clinical Practice Guideline.…”