Clinical and ultrasonographic predictors of maternal morbidities in patients with placenta accreta spectrum

Abdelmoety, Amani; Mosbah, Yaser; Elesawy, Maher; Mahmoud Thabet, Mahmoud Mohamed Abdelrazik ,

doi:10.21608/egyfs.2024.393803

Clinical and ultrasonographic predictors of maternal morbidities in patients with placenta accreta spectrum

Document Type : Original Article

Authors

Amani Abdelmoety ¹
Yaser Mosbah ²
Maher Elesawy ²
Mahmoud Mohamed Abdelrazik , Mahmoud Thabet ³^{, 2}

¹ Resident of Obstetrics and Gynecology, ministry of health and population, Egypt

² Departement of Obstetrics and Gynecology, Mansoura faculty of medicine, Mansoura university, Egypt

³ Assistant professor of Obstetrics and Gynecology, Mansoura Faculty of medicine, Mansoura university, Egypt

10.21608/egyfs.2024.393803

Abstract

Background : The incidence of placenta accreta has been markedly increased. Patients with this condition are exposed to many complications, including massive blood loss, hysterectomy and postpartum haemorrhage.
Aim : To predict maternal morbidities related to placenta accreta spectrum (PAS) using clinical and ultrasonographic criteria so proper preoperative preparation and counselling can be done.
Patients and methods: This study analysed 106 patients diagnosed by ultrasonography as having PAS and conﬁrmed intraoperatively according to FIGO criteria. Planned caesarean sections were done, and the amount of blood loss was calculated. Patients were considered to have massive bleeding if the estimated blood loss was 2500 cc or more.The patients with hysterectomy, bladder injury, and postpartum haemorrhage were identiﬁed, and the association with clinical and sonographic signs were analyzed.
Results: In our study, some ultrasonographic signs such as placenta previa complete centralis, lacunae grading and bridging vessels were associated with massive intraoperative bleeding with Odds ratio 1.47 95% CI (1.35-1.75) (p=0.014) for lacunae grade 2 and 1.26 95% CI (1.07-1.61) (p=0.048) for bridging vessels. However, none of them was an independent predictor for massive intraoperative blood loss in regression analysis. The risk of hysterectomy was increased in patients with lacunae grade 3 (p <0.001), while the risk for bladder injury was signiﬁcantly increased with bridging vessels
( p=0.048). None of the clinical characteristics have a relation to maternal morbidities.
Conclusion: None of the patient,s clinical characteristics statistically linked to maternal morbidities. The ultrasonographic signs of PAS could allow the prediction of maternal complications.

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