EP16.20: Ultrasound diagnosis of PAS and surgery results

PAS is a grave complication that is accompanied by severe, life-threatening hemorrhagic complications during labour, which can be prevented. Over the past 3 years, we have had experience in ultrasound diagnosis and surgical delivery of 5 cases of PAS at 26-34 weeks: 4 singleton and 1 DC twin. 4 had a previous Caesarean section at 2-6 years ago, 1 had 2 previous Caesarean scars. In all cases had has a low or previa placenta in the scar zone. In 3 cases of singleton and 1case of twins, ultrasound signs of PAS were first detected at 26-28weeks, in 2 cases - at 34-36 weeks. There were no dynamic changes of the detected signs at subsequent ultrasound examinations from 26-28weeks. In 4 cases, the US signs were present: loss of retroplacental hypoechoic clear space, increased vascularity on Doppler, myometrial thinning <1mm, lacunae, which were interpreted as signs of placenta accreta/increta and preoperatively assumed to be FIGO grade2. In 1case, in addition to the above signs, myometrium undetectable and bulge was detected, which was preoperatively interpreted as placenta percreta, FIGO grade3. All women had a planned Caesarean section at 36 weeks by a specialised team. In all cases, the pre- and postoperative diagnoses were consistent. The surgical included: CS, bilateral arteria iliaca interna ligation, partial myometrium resection with metroplasics in cases of preoperatively determined as FIGO grade 2 and FIGO grade 3. Thus, hysterectomy was avoided. Conclusions: The combined assessment of US signs of PAS in low-lying and previa placenta with a previous Caesarean scar was effective in detecting and differentiating placenta accreta/increta/percreta from 26weeks. The assessment of US signs has a correlation with the FIGO criteria, according to which surgical delivery was planned. Which made it possible to perform reconstructive surgery on the uterus instead of hysterectomy both in cases of placenta accreta/ increta FIGO grade 2 and placenta percreta FIGO grade 3.