EP16.18: Quantitative vascularisation of the cervix in women with placenta accreta spectrum and its association with severe blood loss at delivery

To propose a semi-quantitative approach for evaluating cervical vascularisation in women with placenta accreta spectrum (PAS) using standard transvaginal ultrasound (TVUS) settings, and to assess its correlation with the severity of PAS and blood loss during delivery. We conducted a retrospective cohort study evaluating 73 patients referred for suspicion of PAS on ultrasound. A TVUS was performed, directional colour Doppler ultrasound (CDU) was adjusted to include the complete cervix with following settings PRF= 22-25 cm/sec, medium filter, and 1.4 dB gain. A video clip was obtained and saved for off-line analysis. Quantitative vascularisation (QV) was analysed using Image J® software, measuring colour intensity expressed in the green channel (RGB, red, green, blue channels) relative to total gray intensity, and expressed as percentage. The severity of PAS (accreta (PA), increta (PI), percreta (PP)) was determined by pathology report, or when the diagnosis of PAS was not confirmed by US and the placenta was normally removed during Caesarean section. Severe blood loss was defined as ≥2500mL at birth. Differences in QV were computed among different degrees of PAS severity, and between patients with and without severe blood loss at delivery. There was a significant difference in QV between patients without PAS (n = 23; mean ± SD: 1.94 ± 2.2) and those with PI (n = 19; 6.56 (6.6), p = 0.003) and PP (n = 6; 5.20 (4.08), p = 0.001), but not with PA (n = 25; 2.63 (2.96), p = 0.3). Patients with PA had lower QV than those with PI (p = 0.007) and PP (p = 0.08). No differences in QV were observed between individuals with PI vs. PP (p = 0.6) or between those with (n = 12; 4.34 (2.67)) and without (n = 61; 3.61 (4.75; p = 0.5)) severe blood loss at delivery. QV of cervix can contribute to the diagnosis of placenta percreta and increta. Blood loss at birth cannot be accurately predicted, however this is multifactorial and can be related to several factors including indication for delivery, and surgery.