The diagnostic accuracy of ultrasound in the prediction of placenta accreta spectrum (PAS)

Document Type : Original Article

Author

Assistant Professor of Obstetrics and Gynecology (Faculty of Medicine-Cairo University)

Abstract

Abstract
Objective: To evaluate the ability of each sonographic parameter in the prediction of PAS and to correlate this ultrasound assessment to operative judgement of an experienced accreta team and to histopathology of the specimen
in cases who were indicated for hysterectomy.
Materials and Methods: A total of 60 patients diagnosed
as having placenta previa with high possibility of placenta
accreta, PAS was diagnosed by the presence of at least one
of the following features in color Doppler scan: diffuse or
focal lacunar flow, sonolucent vascular lakes and hypervascularity of the utero-vesical interface with bridging vessels
connecting the placenta to the bladder. The sonographic
provisional diagnosis of accreta was documented. An experienced accrete team who were blinded for the ultrasound
result made an intraoperative judgment and classified the
case to either (mostly accreta) or mostly (non accreta). Histopathological examination was done to assess the presence of placental invasion & to confirm the diagnosis of
placenta accreta for the specimens who required hysterectomy by a pathologist who were also blinded for the ultrasound diagnosis,
Results: Placental invasion was found in 35(58.3%) by ultrasound examination of placenta previa cases. Intraoperatively, 36 (60%) patients were assessed to have morbidly
adherent placenta (MAP). By histopathological examination
16 cases (45.7 %) were confirmed as placenta accreta and
19 cases (54.3 %) were confirmed as placenta increta .Out
of the different ultrasound parameters abnormal lacunae was
found to have the highest sensitivity, specificity, PPV, NPV
and accuracy in its relation to both intraoperative assessment
and histopathological analysis.
Conclusion: prenatal ultrasound is the best screening tool
for PAS and presence of abnormal lacunae and loss of retro-placental clear zone are accurate predictors for the operative findings and histopathological diagnosis.

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