Novel markers of doppler ultrasonography in the placenta accreta spectrum to predict complications.

Abstract

Ultrasonography is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women; however, the lack of a strong criteria protocol in diagnosis and predicting the severity of the consequences facing pregnant women requires novel markers investigation. This prospective cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Therefore, 51 pregnant women were involved in the study. Their characteristic information, medical and surgical history, blood loss severity(severe:>=2500 ml), following hysterectomy, and the histopathology after the surgery were collected. Also, the Doppler of right and left uterine arteries, including the pulsatility index(PI), resistance Index(RI), peak systolic velocity(PSV), the PSV of the posterior part of the bladder, cervix, the largest lacuna, and the posterior lacuna of the bladder were calculated by Doppler ultrasonography. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS(bleeding, hysterectomy, pathology). The mean age of the pregnant women was 35.4±4.11 (median:35.00) years. 17(33.3%) of pregnant women had severe Bleeding. The median of bladder PSV, cervix PSV, and left uterine artery for women with severe bleeding were 57.00(34,90), 26.00(0,63), and 89.00(81,135), while there were 33.00(20,64), 18.00(0.76), and 68.00(61,113) for women without severe bleeding (p-value: <0.001, 0.037, 0.045). 34 (66.66%) pregnant women had hysterectomy. Bladder PSV, cervix PSV, and left uterine PSV for women with hysterectomy were 46.00(20,90), 20.00(0,76), and 68.00(61,135) compared to 39.50(33,46), 20.00(14,26), and 82.00(63,101) for women without (p-value=0.005, 0.013, 0.003). Bladder PSV, cervix PSV, and uterine PSV are significantly higher in pregnant women with PSV, and they can be appropriate markers in diagnosing PAS and predicting its severity. So that healthcare providers could use them to make better clinical decisions.