Prediction of Bleeding in Placenta Accrete Spectrum with Lacunar Surface; A Novel Aspect

Abstract Background: Diagnosing the placenta accreta spectrum for suspicious pregnant women is crucial to prevent morbidities and mortalities among them. We aim to evaluate the novel ultrasonography markers for these patients in diagnosis and predicting prognosis. Method and Materials: This cross-sectional study was performed in a referral academic hospital. The population was 51 pregnant women suspicious of PAS. Their primary information and medical and surgical histories were documented. Then the ultrasonography markers, including the most bulging volume behind the bladder(area, perimeter, and volume), the Lacune(diameter, length, number, and surface of the largest lacuna obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jellyfish sign, and sponge cervix were evaluated. Their comparison to the severity of the bleeding, the rate of the hysterectomy, and the following pathology of the PAS were analyzed. Result: 17(33.3%) of patients had severe bleeding. The diameter, length, and surface of the largest lacunae limited to women with severe bleeding were 13.50(5.5-21), 20.50(11-56), 273.00(60-1176), and they were 11.00(5-24), 16.25(10-39), and 176.25 (50-744) for women without severe bleeding (P-value= 0.039, 0.027, 0.021). 13(76.5%) women with severe bleeding had Jellyfish signs,16(94.2%) had bulging on the cervix, and 10(58.8%) had sponge cervix (P-value=0.046, 0.036, 0.006). 34 (66.66%) patients needed hysterectomy. The diameter, length, and surface of the largest lacunae limited to women with hysterectomy were 11.00(5-24), 17.50(10-39), 181.50 (50-744), and they were 15.00(12-18), 20.50(14-27), and 327.00(168-1176) for women without hysterectomy (P-value= 0.012, 0.070, 0.021). 24(70.6%) women with hysterectomy had Jellyfish signs, 29(85.3%) of them had bulging on the cervix, and 15(44.1%) had sponge cervix (P-value=0.05, 0.036,0.028 ). the cut-off associated with the Lacunar surface was 163.5 Its sensitivity was 80%. Its specificity was 48% (p-value=0.021). Conclusion: The presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accreta spectrum; also, there are some other US criteria, including the presence of sponge cervix and Jellyfish sign as predictive factors for consequences in this spectrum, including hysterectomy.