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The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the value of various grey-scale ultrasound, 2D color Doppler, and 3D power Doppler sonographic markers in predicting major intraoperative blood loss during planned cesarean hysterectomy for cases diagnosed with placenta accreta spectrum (PAS) disorders.

Methods

50 women diagnosed with PAS were scanned the day before planned delivery and hysterectomy for various sonographic markers indicative of placental invasion. These women were then later divided according to blood loss in two groups: group A (minor hemorrhage, < 2500 ml), and group B (major hemorrhage, > 2500 ml), and the data were analyzed.

Results

The odds ratio (OR) for major hemorrhage was as follows for the following sonographic markers: ‘number of lacunae > 4′ OR 3.8 95% CI (1.0–13.8) (p = 0.047); ‘subplacental hypervascularity’ OR 10.8 95% CI (1.2–98.0) (p = 0.035); ‘tortuous vascularity with ‘chaotic branching’ OR 10.8 95%CI (1.2–98.0) (p = 0.035); ‘numerous coherent vessels involving the serosa–bladder interface OR 14.6 95% CI (2.7–80.5) (p = 0.002); and ‘presence of bridging vessels OR 2.9 95% CI (1.4–6.9) (p = 0.005). Only the presence of numerous coherent vessels involving the bladder–serosal interface (p = 0.002) was proven to be independent predictor of major hemorrhage during hysterectomy.

Conclusion

The use of 2D color Doppler and 3D power Doppler can help predict massive hemorrhage in cases of PAS disorders.

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Abbreviations

AIP:

Abnormally invasive placenta

PAS:

Placenta accreta spectrum

PRBCs:

Packed red blood cells

RBCs:

Red blood cells

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Funding

This research did not receive any specific grant from any funding agency in the public, commercial or nonprofit sector.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Giza, Egypt

    Ahmed M. Hussein, Mohamed Momtaz, Ahmad Elsheikhah, Ahmed Abdelbar & Ahmed Kamel

Authors
  1. Ahmed M. Hussein
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  2. Mohamed Momtaz
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  3. Ahmad Elsheikhah
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  4. Ahmed Abdelbar
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  5. Ahmed Kamel
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Contributions

AMH: Protocol/project development, obstetrics and gynecological surgery, data collection or management, data analysis, manuscript writing/editing. MM: Protocol/project development, data analysis, manuscript writing/editing. AES: Protocol/project development, data collection or management, manuscript writing/editing. AA: Protocol/project development, obstetrics and gynecological surgery, data collection or management, manuscript writing/editing. AK: Protocol/project development, data collection or management, data analysis, manuscript writing/editing.

Corresponding author

Correspondence to Ahmed Kamel.

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Conflict of interest

The authors of this study declare no conflict of interest and no competing interests with respect to the research, authorship and publication of this article.

Ethical approval

The study protocol was approved by the scientific and ethics committee of Obstetrics and Gynecology department on February 2017.

Informed consent

The participating women were counseled about their condition, the management plan as well as the possible complications, and signed an informed consent.

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Hussein, A.M., Momtaz, M., Elsheikhah, A. et al. The role of ultrasound in prediction of intra-operative blood loss in cases of placenta accreta spectrum disorders. Arch Gynecol Obstet 302, 1143–1150 (2020). https://doi.org/10.1007/s00404-020-05707-y

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  • DOI: https://doi.org/10.1007/s00404-020-05707-y

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