PAS or Not PAS? The Sonographic Assessment of Placenta Accreta Spectrum Disorders and the Clinical Validation of a New Diagnostic and Prognostic Scoring System

This study aimed to evaluate our center's experience in diagnosing and managing placenta accreta spectrum (PAS) in a high-risk population, focusing on prenatal ultrasound features associated with PAS severity and maternal outcomes. We conducted a retrospective analysis of 102 high-risk patients with confirmed placenta previa who delivered at our center between 2018 and 2023. Patients underwent transabdominal and transvaginal ultrasound scans, assessing typical sonographic features. Binary and multivariate logistic regression analyses were performed to identify sonographic markers predictive of PAS and relative complications. Key ultrasound features-retroplacental myometrial thinning (<1 mm), vascular lacunae, and retroplacental vascularization-were significantly associated with PAS and a higher risk of surgical complications. An exceedingly rare sign, the "riddled cervix" sign, was observed in only three patients with extensive cervical or parametrial involvement. Those patients had the worst surgical outcomes. This study highlights the utility of specific ultrasound features in stratifying PAS risk and guiding clinical and surgical management in high-risk pregnancies. The findings support integrating these markers into prenatal diagnostic protocols to improve patient outcomes and inform surgical planning.