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

Abstract

Background: Placenta accreta spectrum [PAS] is one of the most dangerous complications in pregnancy after cesarean section, with high perinatal mortality. The first-line imaging methods employed in the evaluation of placenta accrete include grey scale and Doppler scanning. Aim of the work: To evaluate the efficacy of grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss for cases diagnosed with placenta accreta spectrum [PAS] disorders.Patients and Methods: The day before an expected delivery and hysterectomy, 59 women with PAS were examined for several sonographic indicators of placental invasion. After that, the women were split into two groups, group A [small hemorrhage, less than 2000 ml], and group B [major hemorrhage, greater than 2000 ml], and the results were examined.Results: In major group participants had higher number of previous CS as well as Gravidity, while gestational age in both groups were insignificantly different. We found significant higher US finding in Major group in all US parameter. The mean PAS score was 13.3 ± 3.2. 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.Conclusion: When there are PAS abnormalities present, the use of 2D color Doppler and 3D power Doppler can aid in the prediction of severe bleeding. Placental lacuna, hypoechoic regions, and bridging vessels were the key predictors.

Keywords

• abnormally invasive placenta
• accreta
• blood loss
• placenta accreta spectrum