A Clinico-Sonographic Scoring System for Diagnosing Placenta Accreta Spectrum and Predicting Peripartum Hysterectomy Risk

To develop and evaluate a clinico-sonographic scoring system combining prenatal ultrasound findings and maternal clinical history for diagnosing placenta accreta spectrum (PAS) and predicting peripartum hysterectomy. We analyzed clinical and ultrasound data from 77 pregnant women with persistent placenta previa and prior cesarean delivery evaluated at a tertiary referral center between 2022 and 2024. Five patients were excluded because of incomplete data or loss to follow-up, leaving 72 patients in the final cohort. Multivariable logistic regression and clinical weighting were used to model PAS risk based on sonographic features (placental lacunae, retroplacental myometrial thickness, placental thickness, and bridging vessels) and maternal symptomatology (third-trimester bleeding). Surgical findings and histopathologic examination served as the reference standard. Peripartum hysterectomy was performed in 30 patients (41.7%; 15 percreta, 10 increta, 4 accreta, and 1 non-PAS). The clinico-sonographic score yielded an area under the receiver operating characteristic curve (AUC) of 0.907 (95% CI: 0.840-0.975) for diagnosing PAS. A score cutoff of ≥3.5 had a sensitivity of 85.1% and a specificity of 87.2%. For predicting peripartum hysterectomy, the same cutoff yielded a sensitivity of 96.7% and a specificity of 61.9% (AUC: 0.875, 95% CI: 0.795-0.955). A cutoff of ≥5.5 predicted placenta percreta with 69.2% sensitivity, 76.9% specificity, and an AUC of 0.806 (95% CI: 0.687-0.924). A clinico-sonographic scoring system combining prenatal ultrasound markers with third-trimester bleeding stratifies PAS risk and identifies patients at increased risk of peripartum hysterectomy. Prospective external validation in independent cohorts is required before clinical implementation.