Rail Sign by Doppler ultrasound as a predictor of outcome of placenta accreta spectrum

Background: Placenta accreta spectrum (PAS) involves abnormal placental invasion into uterine wall and is associated with life-threatening maternal complications. Doppler ultrasound is the primary diagnostic tool, though its ability to determine invasion depth and predict outcomes remains uncertain. Multidisciplinary management improves safety, and treatment often requires planned cesarean hysterectomy, or conservative management. The aim of this work was to correlate rail signs by Doppler US as a predictor of deep villous invasion and to detect whether rail signs can predict maternal and fetal outcomes. Methods: This prospective observational study was conducted on 59 patients aged > 20 years old, with PAS on US. Patients were categorized into two groups: Group 1: revealed rail sign by Doppler US (n=37) and Group 2: without rail sign (n=22). Results: In univariate regression analysis, the presence of rail sign was associated with poor outcomes, including longer intraoperative time, increased blood loss, higher transfusion requirements, greater surgical complexity, prolonged postoperative hospital stay, and increased maternal, neonatal ICU admission. However when adjusted for other factors in multivariate analysis, the rail sign was no longer an independent predictor of these adverse outcomes. This suggests that the initial association was driven by other confounding factors as FIGO grading. Conclusions: Maternal morbidity, including increased blood loss, blood transfusion, critical care unit admission, length of hospital stay, and more complicated surgery were associated with the rail sign. As regard fetal outcomes, neonatal intensive care unit (NICU) admission was more common.