Correlation between Sonographic Findings of Intra-Placental Lacunae with Intra Partum Hemorrhage During Cesarean section in Patients with Placenta Previa

Background: One in every thousand pregnancies is affected by placenta previa (PP), an obstetric problem. The internal opening of the cervix is partially or completely blocked by the placenta in this circumstance. There are four different kinds of placenta previa: low-lying, marginal, partial, and complete. Aim: To analyze a large number of patients who underwent elective cesarean sections (CS) and to find out whether there is a correlation between the ultrasound results (placental lacunae and sponge-shaped echoes) and the amount of intrapartum bleeding. Subjects and methods: A total of one hundred sixty-five pregnant women from the obstetrics and gynecology departments of Al-Hussien and Sayed Galal Hospitals, AL-Azhar University in Cairo, Egypt, participated in the study. Results: The majority (89.4%) had no abnormal placental invasion, with only 10.6% showing placenta accreta, Grade-1: a notable increase in placenta accreta cases (39.7%), with fewer cases had no invasion (60.3%), Grade-2: shows a shift towards more severe invasion types, with 44.8% Increta and 44.8% Percreta, while placenta accreta is present in only 10.3%., and Grade-3: The most severe cases, with 80.6% Increta and 19.4% Percreta, and no cases of placenta accreta, regarding the grades, there is a statistically significant difference (P≤0.001). Conclusion: Higher grades of placental lacunae and the presence of echoes on ultrasound are significantly associated with increased severity of placental invasion and greater blood volume loss during delivery. These findings are further correlated with adverse maternal outcomes, including higher rates of massive transfusion, ICU admission, disseminated intravascular coagulation, and cesarean hysterectomy.