<b>Role of Gray Scale and Doppler Ultrasound Scoring in Predicting the Severity of Placenta Accreta Spectrum in High Risk Pregnancies</b>

Background: Despite advancements in imaging, the subjectivity of ultrasonography (USG) interpretation and lack of standardized scoring systems contribute to underdiagnosis or overdiagnosis of placenta accreta spectrum (PAS). Objectives: To evaluate the diagnostic accuracy of SG scoring systems in predicting PAS and to correlate these scores with intraoperative findings in patients undergoing cesarean delivery. Methods: This cross-sectional study, conducted at the Department of Radiology, PNS Shifa, Karachi, Pakistan, from October 2024 to March 2025, evaluated the diagnostic accuracy of USG scoring in predicting PAS and its correlation with intraoperative findings. A sample of 61 high-risk pregnant women with prior cesarean sections and suspected PAS was included using non-probability, consecutive sampling technique. Gestational age, placental location, retroplacental myometrial thickness, bladder wall integrity, vascular lacunae, and traversing vessels were assessed via gray-scale and doppler USG. A structured scoring system classified PAS severity: scores 5–10 indicated accreta/increta, >10 indicated percreta, and <5 indicated no PAS. Intraoperative findings confirmed PAS diagnosis. Data were analyzed using IBM-SPSS Statistics, version 26.0. P<0.05 was taken significant. Results: The mean gestational age at delivery was 34.12±2.54 weeks, with 88.5% (n=54) delivering preterm. PAS was identified in 23.0% (n=14) via USG and 21.3% (n=13) intraoperatively. USG scoring system demonstrated sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy as 100%, 97.9%, 92.9%, 100%, and 98.4% respectively. ROC analysis showed excellent performance (AUC=0.990, p<0.001), with perfect classification for percreta (AUC=1.00, p<0.001). Conclusion: This study confirms that ultrasound scoring is a highly accurate and reliable tool for diagnosing PAS.