Ultrasound Screening of Placenta Accreta Spectrum in Early Pregnancy

Placenta accreta spectrum (PAS) is associated with serious complications. Early recognition may lead to enhanced care, counseling and more favorable pregnancy outcomes. To evaluate the role of first trimester ultrasound in early prediction of PAS and subsequent management. This is a case-control study of 60 pregnant women with uterine scars and early pregnancy sonographic signs of placenta accreta, who were delivered at Beni-Suef University Hospital. Based on the presence of morbidly adherent placenta (MAP) at the time of delivery, subjects were divided into two groups. Sonographic findings and outcomes were compared in both groups. At Caesarean section, 32/60 patients (53.3%) had evidence of MAP. Older age, higher parity and number of previous sections were significantly associated both with the presence of MAP and with the requirement for Caesarean-Hysterectomy. During first trimester scan, bridging vessels and low gestational sac were the most common findings (n=35 & 34 respectively). All sonographic findings were significantly associated with the presence of MAP. Using weighted OR model, thin myometrium and lacunae had significant independent associations with MAP (p=0.02 & 0.008 respectively). Regarding third trimester scans, sonographic evidence of placenta accreta was present in all patients with MAP at C.S. and only 29% in those without (100% sensitivity, 71% specificity; p=0.001). Post-partum hemorrhage and transfusion requirement were present in 36 cases (60%), including 94% oi cases of MAP (p=0.001). Pelvic devascularization, hysterectomy and ICU admission only occurred in those with MAP. Early sonographic assessment of pregnancies with previous cesarean delivery or uterine surgery can predict the presence of MAP disorder and improve the surgical outcome.