Ultrasound Prediction of Bleeding in Placenta Accreta Spectrum with Lacunar Surface

The diagnosis of placenta accreta spectrum (PAS) is critical to prevent significant morbidity and mortality in pregnant women suspected of this condition. This cross-sectional study assessed novel ultrasonographic markers in 51 pregnant women with suspected PAS scheduled for cesarean sections. Key ultrasonographic indicators evaluated included the bulging volume behind the bladder, lacuna characteristics (diameter, length, number, and surface area), placenta thickness at the cervix, the Jellyfish sign, and the sponge cervix. The study aimed to correlate these markers with the severity of bleeding, hysterectomy rates, and pathology outcomes associated with PAS. Results indicated that 33.3% of participants experienced severe bleeding (over 2500 cc). Notably, women with severe bleeding demonstrated larger lacunae measurements, with diameters of 13.5 mm compared to 11 mm in those without severe bleeding. Additionally, significant correlations were found between the presence of the Jellyfish sign (76.5% prevalence in those with severe bleeding) and the sponge cervix (58.8% prevalence). Of the patients, 66.66% required hysterectomy, and those undergoing this procedure also exhibited larger lacuna sizes and significant ultrasonographic signs. The study identified a lacunar surface area cut-off of 163.5 mm², with a sensitivity of 80% and specificity of 48% in predicting bleeding. In conclusion, the presence of large lacunae, along with other ultrasonographic signs, serves as valuable predictive markers for adverse outcomes in patients with PAS, highlighting the importance of these imaging techniques in clinical decision-making.