The role of 2D ultrasound & colour Doppler in prediction of intra-operative blood loss in placenta accreta spectrum disorders

Placenta accreta spectrum (PAS) is a severe and potentially fatal obstetric condition characterized by abnormal placental adherence resulting from the invasion of chorionic villi into the myometrial layer. This study aimed to investigate the predictive value of 2D ultrasound signs and Doppler evaluation for major intraoperative blood loss in women undergoing cesarean section (CS) with a diagnosis of PAS. Methods: This prospective cohort study enrolled 50 cases with a confirmed diagnosis of PAS. Each case underwent comprehensive history taking, clinical and abdominal examinations, as well as detailed ultrasound assessment. Results: Intraoperative blood loss was significantly higher in participants with surface lacunae, bridging vessels, sub placental hyper vasculature, and intra placental hyper vasculature compared to participants without. The number of placental lacunae, presence of surface lacunae, absence of clear zone, length of utero vesical vasculature, presence of bridging vessels, presence of sub placental hyper vasculature, and retro placental myometrial thickness are significant predictors of intraoperative bleeding. Conclusion: Our study emphasizes the pivotal role of 2D ultrasound and Doppler imaging in forecasting intraoperative blood loss among cases with PAS undergoing CS. Specific markers, including surface lacunae, bridging vessels, subplacental hypervascularity, and the number of placental lacunae, were identified as key predictors of significant hemorrhage.