A study published in the British Journal of Obstetrics and Gynaecology has defined ultrasound findings, which can help to identify patients at risk of placenta accreta spectrum, intraoperative hemorrhage and need for hysterectomy.¹

This cohort study was conducted at the Cairo University Maternity Hospital in Egypt to identify factors that could predict surgical outcomes in patients at high risk for placenta accreta spectrum. Pregnant women with history of previous cesarean section with placenta previa with or without PAS confirmed by histopathology were included in the study group.

Out of the 90 medical records examined, 58 (~65%) were found to have placenta accreta spectrum. Of these, 60 cases (66.7%) needed a primary cesarean hysterectomy, which was the primary outcome of the study.  The probability of hysterectomy was higher in patients with complete placenta previa.

Preoperative ultrasound features that were associated with greater odds of hysterectomy included subplacental hypervascularity (7.23), bridging vessels (2.00), lacunar feeder vessels (5.69) and lacunar scores 2+ and 3+ (12.6). The finding of increased lower segment vascularization during laparotomy significantly correlated with greater likelihood of hysterectomy. Presence of feeder vessels and the number of lacunae were associated with requirements of 5 or more units of red blood cell transfusions with odds ratios of 1.62 and 1.48, respectively. A significant association was found between parity, placental location and placenta accreta spectrum and hysterectomy on multivariate analysis.

Placenta accreta spectrum, earlier known as morbidly adherent placenta, includes placenta increta, placenta percreta and placenta accreta, conditions depicting varying pathologic adherence of the placenta. It is a major cause of maternal morbidity and mortality. Attempt to forcibly remove the placenta after delivery can result in massive uncontrolled hemorrhage, which can be potentially fatal. Preoperative diagnosis improves prognosis for both the mother and the baby.² Awareness of risk factors can greatly aid diagnosis.

References

1. Hussein AH, et al. The impact of preoperative ultrasound and intraoperative findings on surgical outcomes in patients at high risk of placenta accreta spectrum. BJOG. 2023 Jan;130(1):42-50. doi: 10.1111/1471-0528.17286.
2. American College of Obstetricians and Gynecologists; Society for Maternal-Fetal Medicine. Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstet Gynecol. 2018 Dec;132(6):e259-e275. doi: 10.1097/AOG.0000000000002983.