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

Fahimeh Gotbizadeh Vahdani; Azadeh Shabani; Mohammad Haddadi; Seyedeh Mojgan Ghalandarpoor-Attar; Zahra Panahi; Sedigheh Hantoushzadeh; Sedighe Borna; Maryam Deldar Pasikhani; Sanaz Ghashghaee; Mamak Shariat

doi:10.4274/jtgga.galenos.2023.2023-2-10

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

J Turk Ger Gynecol Assoc. 2023 Dec 6;24(4):228-234. doi: 10.4274/jtgga.galenos.2023.2023-2-10. Epub 2023 Oct 26.

Affiliations

¹ Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
² Department of Obstetrics and Gynecology, Preventative Gynecology Research Center (PGRC), School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
³ Vali-e-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
⁴ Department of Obstetrics and Gynecology, Baharloo Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁵ Department of Obstetrics and Gynecology, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
⁶ Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

PMID: 37882615
PMCID: PMC10702256
DOI: 10.4274/jtgga.galenos.2023.2023-2-10

Abstract

Objective: Ultrasonography (US) is an acceptable tool to diagnose the placenta accreta spectrum (PAS) among pregnant women. However, the lack of a robust criteria for diagnosis and predicting the severity of the consequences facing pregnant women requires identification of novel biomarkers.

Material and methods: This prospective, cross-sectional study was performed on pregnant women with a probable diagnosis of PAS. Their demographic information, medical and surgical history, blood loss severity (severe ≥2500 mL) following hysterectomy, and the histopathology after the surgery were collected. In addition, the Doppler imaging of both uterine arteries, including the pulsatility index, resistance index, 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 US. Data were analyzed to investigate the relationship between Doppler markers and the severity of PAS in terms of bleeding, hysterectomy, and histopathology.

Results: Fifty-one women were enrolled with a mean age of 35.4±4.11 years and 17 (33.3%) had severe bleeding. There were significant differences between median (range) bladder PSV [57 (34-90) vs. 33 (20-64); p<0.001], cervix PSV [26 (0-63) vs. 18 (0-76); p=0.04] and left uterine artery [89 (81-135) vs. 68 (61-113); p=0.045] for women with and without severe bleeding, respectively. Thirty-four (66.66%) had hysterectomy. Comparison of bladder PSV, cervix PSV, and left uterine PSV for women with and without hysterectomy were 46 (20-90) vs. 39.5 (33-46) (p=0.005), 20 (0-76) vs. 20 (14-26) (p=0.013) and 68 (61-135) vs. 82 (63-101) (p=0.003), respectively.

Conclusion: Bladder PSV, cervix PSV, and uterine PSV were significantly higher in pregnant women with PAS, and they may be useful diagnostic and prognostic markers.

Keywords: Doppler ultrasonography; PAS; PSV; hemorrhage; hysterectomy; placenta accreta spectrum.