The Role of Transvaginal Ultrasound in the Third-Trimester Evaluation of Patients at High Risk of Placenta Accreta Spectrum at Birth

( Am J Obstet Gynecol . 2023;229(4):445.e1–445.e11. doi: 10.1016/j.ajog/2023.05.004) Identifying high-risk placenta accreta spectrum (PAS) patients prenatally reduces maternal complications and hemorrhagic morbidity at birth. Expert multidisciplinary management decreases massive transfusion and reoperation. Ultrasound, utilized initially in 1982, screens high-risk PAS cases effectively and standardized prenatal scanning with enhances outcomes. Recent expert consensus via Delphi survey supports seven key transabdominal ultrasound (TAU) signs for PAS risk assessment. Transvaginal sonography (TVS) is a vital tool for the evaluation of cervical and lower uterine segment anatomy and expert opinion supports the use of TVS as a supplement to current prenatal assessment for PAS. This study evaluated the utility of third trimester TVS to predict surgical outcomes in patients with high suspicion for PAS.