POSSIBILITIES OF ULTRASOUND MARKERS OF PAS IN PREDICTING THE RISK OF
POSTPARTUM HEMORRHAGE IN PREGNANT WOMEN WITH A UTERINE SCAR
Pomortsev A.V.1,2, Kuzmenko N.N.1,2, Kuzmenko E.A.1,2, Dyachenko Yu.Yu.1.
1 - Kuban State Medical University. Krasnodar, Russia.
2 - Regional Clinical Hospital No. 2. Krasnodar, Russia.
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urpose. To study the diagnostic capabilities of various ultrasound markers of placental ingrowth as predictors of intraoperative bleeding.
Materials and methods. A total of 124 pregnant women with signs of ingrowth were examined on ultrasound at 33-36 weeks. The research was carried out by expert-level ultrasound scanners Philips Voluson S8 and Samsung W10. Based on intraoperative parameters, two groups were distinguished: with blood loss up to 1000 ml (n=58) and with blood loss of more than 1000 ml (n=66). The ratio of the following ultrasound markers of placental ingrowth in each of the groups was analyzed: disappearance of the normal hypoechoic retroplacentric zone, multiple vascular lacunae in the maternal surface of the placenta, thinning of the myometrium over the placenta, protrusion of placental fragments, hypervascularization of the vesicouterine zone and subplacental hypervascularization, followed by the construction of a prognostic model using logistic regression.
Results. A statically significant regression model (p=0.015) was obtained for the feature "protrusion of the uterus external contour", the area under the ROC curve was 0.617 ± 0.071 with 95% CI: 0.477–0.757. The sensitivity and specificity of the model were 30.3% and 93.1%, respectively. Also the model was statistically significant developed for the feature of "subplacental hypervascularization" (p=0.027). The area under the ROC curve was 0.610 ± 0.072 with 95% CI: 0.469–0.750, the sensitivity and specificity of the model were 90.9% and 31.0%, respectively. In other cases, the statistical significance of the examined models was not obtained. At the same time, the models of most of the signs had low levels of sensitivity and specificity: "presence of intraplacental lacunae" (66.7% and 48.3%, respectively), "thinning of the myometrium over the placenta" (60.6% and 44.8%), "hypervascularization of the vesicouterine zone" (51.5% and 55.2%).
Discussion. The results of linear regression analysis showed that such signs as "local placental bulging" and "subplacental hypervascularization" were significantly associated with an increase in intraoperative blood loss. At the same time, the sign of "subplacental hypervascularia" made it possible to predict blood loss with high sensitivity and low specificity, and the sign of "local placental protrusion" showed the opposite results, predicting a high risk of bleeding with high sensitivity, but low specificity.
Conclusion. The use of only echographic markers of placental ingrowth does not allow us to reliably predict the risk of intraoperative bleeding.
Keywords: placenta accreta spectrum, ultrasound (US), obstetric hemorrhage, PAS.
Corresponding author: Kuzmenko N.N., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Pomortsev A.V., Kuzmenko N.N., Kuzmenko E.A., Dyachenko Yu.Yu. Possibilities of ultrasound markers of pas in predicting the risk of postpartum hemorrhage in pregnant women with a uterine scar. REJR 2025; 15(3):163-173. DOI: 10.21569/2222-7415-2025-15-3-163-173.
Received: 20.02.25 Accepted: 30.10.25