Effectiveness of ultrasound screening for pathological placentation in women with a uterine scar after cesarean section based on standard sonographic criteria
DOI:
https://doi.org/10.15574/PP.2025.3(103).8291Keywords:
cesarean scar, cesarean section, ultrasound, grayscale imaging, color Doppler, pathological placentation, normal placentationAbstract
Pathological placentation, including placenta previa (PP) and placenta accreta spectrum (PAS), is a major pregnancy complication in women with a cesarean section (CS) scar compared to normal placentation. Ultrasound with standardized sonographic criteria remains a key tool for timely detection of these conditions.
Aim - to assess the effectiveness of ultrasound screening for pathological placentation in women with a CS scar compared to NP using standard sonographic markers for early identification of PP and PAS.
Materials and methods. Between January 2020 and January 2023, 284 pregnant women with PP delivered at the Kyiv Perinatal Center. Among them, 145 had a CS scar, and 66 were suspected of PAS. Ultrasound examinations were performed using a Voluson 10 system in grayscale and color Doppler modes.
Results. In normal placentation, the “clear zone” was preserved, whereas in pathological placentation it was absent or irregular, serving as an early PAS marker. PP showed mild myometrial thinning and lacunae without abnormal blood flow, while PAS was associated with marked myometrial thinning (<1 mm), asymmetric “torn” lacunae, and turbulent blood flow. Uterine contour deformation and vesicouterine hypervascularization with bridging vessels were key indicators of deep invasion and critical for cesarean delivery planning.
Conclusions. PAS and PP features may coexist in the same placental bed, complicating differential diagnosis. Ultrasound screening in women with a CS scar is informative when standard markers are assessed comprehensively: myometrial thinning, loss of the “clear zone”, and vascular changes allow early detection, while exophytic masses and uterine protrusion toward the bladder identify severe PAS forms, including placenta percreta.
The investigation is consistent with the principles of the Declaration of Helsinki. The patient's information was withheld from the investigation.
The authors declare that there is a conflict of interest.
References
ADoPAD (Antenatal Diagnosis of Placental Attachment Disorders) study group. (2025, Jul). Risk factors, prenatal diagnosis, and outcome of posterior placenta accreta spectrum disorders in patients with placenta previa or low-lying placenta: A multicenter study. Acta Obstet Gynecol Scand. 104(7): 1328-1338. https://doi.org/10.1111/aogs.15132; PMid:40387324 PMCid:PMC12144582
Abinader RR, Macdisi N, El Moudden I, Abuhamad A. (2022, Apr). First-trimester ultrasound diagnostic features of placenta accreta spectrum in low-implantation pregnancy. Ultrasound Obstet Gynecol. 59(4): 457-464. https://doi.org/10.1002/uog.24828; PMid:34837427
Bartels HC, Walsh JM, Carroll S et al. (2025, Apr). Prenatal detection of placenta accreta spectrum using a sonographic checklist. Acta Obstet Gynecol Scand. 104; Suppl 1: 56-65. https://doi.org/10.1111/aogs.14943; PMid:39356049 PMCid:PMC12087432
Baumann HE, Pawlik LKA, Hoesli I et al. (2023, Jun). Accuracy of ultrasound for the detection of placenta accreta spectrum in a universal screening population. Int J Gynaecol Obstet. 161(3): 920-926. https://doi.org/10.1002/ijgo.14595; PMid:36436922
Chen Q, Shen K, Wu Y et al. (2025). Advances in prenatal diagnosis of placenta accreta spectrum. Medicina. 61(3): 392. https://doi.org/10.3390/medicina61030392; PMid:40142202 PMCid:PMC11943587
D'Antonio F, Iacovella C, Palacios-Jaraquemada J et al. (2021). Prenatal identification of placenta accreta spectrum: systematic review and meta-analysis of ultrasound signs. Ultrasound Obstet Gynecol. 57(4): 510-525. https://doi.org/10.1002/uog.23648; PMid:33838069
Faralli I, Del Negro V, Chinè A et al. (2022, Nov 12). Placenta Accreta Spectrum (PAS) Disorder: Ultrasound versus Magnetic Resonance Imaging. Diagnostics (Basel). 12(11): 2769. https://doi.org/10.3390/diagnostics12112769; PMid:36428829 PMCid:PMC9689630
Ghosal S, Gleason JL, Grantz KL, Chen Z. (2025, May 31). Maternal BMI and Diagnostic Accuracy of Using Estimated Fetal Growth to Predict Abnormal Birthweight: Results from NICHD Fetal Growth Studies. Diagnostics (Basel). 15(11): 1398. https://doi.org/10.3390/diagnostics15111398; PMid:40506970 PMCid:PMC12155272
Hessami K, Horgan R, Munoz JL et al. (2024, Jun). Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 63(6): 723-730. https://doi.org/10.1002/uog.27606; PMid:38324675
Huras H, Cnota W, Czajkowski K et al. (2024). Placenta accreta spectrum (PAS) - prenatal diagnosis and management. The Polish Society of Gynecologists and Obstetricians Guidelines. Ginekol Pol. 95(11): 902-920. https://doi.org/10.5603/gpl.101422; PMid:39513238
Hu M, Du L, Zhang L et al. (2025, May 19). Impact of IVF/ICSI on grades of placenta accreta spectrum disorders and pregnancy outcomes. Reprod Health. 22(1): 85. https://doi.org/10.1186/s12978-025-02031-z; PMid:40389956 PMCid:PMC12090606
Ishchenko GI. (2022). Pathological attachment of the placenta: diagnosis, management and delivery. Ukrainian Journal of Perinatology and Pediatrics. 4(92): 42-49. https://doi.org/10.15574/PP.2022.92.42
Jauniaux E, Ayres-de-Campos D, Langhoff-Roos J et al. (2019, Jul). Placenta Accreta Diagnosis and Management Expert Consensus Panel. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet. 146(1): 20-24. https://doi.org/10.1002/ijgo.12761; PMid:31173360
Jauniaux E, Bhide A. (2024). Prenatal ultrasound diagnosis of placenta accreta spectrum: systematic review. Ultrasound Obstet Gynecol. 63(1): 5-15. https://doi.org/10.1002/uog.26014
Jauniaux E, Hussein AM, Fox KA, Collins SL. (2023). Ultrasound diagnosis and management of placenta accreta spectrum disorders. Am J Obstet Gynecol. 229(1): 1-16. doi: 10.1016/j.ajog.2023.03.050.
Jauniaux E, Zosmer N, D'Antonio F, Hussein AM. (2024, Feb). Placental lakes vs lacunae: spot the differences. Ultrasound Obstet Gynecol. 63(2): 173-180. https://doi.org/10.1002/uog.27453; PMid:37592837
Jenabi E, Najafi-Vosough R, Nazari A. (2024, Oct 18). Obesity and risk of placenta accreta spectrum: A meta-analysis. Open Med (Wars). 19(1): 20241047. https://doi.org/10.1515/med-2024-1047; PMid:39434860 PMCid:PMC11491883
Lakatosh V, Lakatosh P, Kupchik V, Tkalich V, Antoniuk M. (2024). Placenta accreta spectrum: clinical pathway of a patient in the perinatal centre of Kyiv. Neonatology, Surgery and Perinatal Medicine. 14; 3(53): 173-179. https://doi.org/10.24061/2413-4260.XIV.3.53.2024.25
Li DY, Sun ZF, Lu Q. (2025, Oct 23). Diagnostic Value of Combined MRI and Ultrasound Features in Invasive Placenta Accreta and Prediction of Adverse Outcomes. Int J Gen Med. 18: 6443-6453. https://doi.org/10.2147/IJGM.S541907; PMid:41159123 PMCid:PMC12558356
Li Y, Choi HH, Goldstein R et al. (2021, Jun). Placental thickness correlates with placenta accreta spectrum (PAS) disorder in women with placenta previa. Abdom Radiol (NY). 46(6): 2722-2728. https://doi.org/10.1007/s00261-020-02894-9; PMid:33388802
Maged AM, El-Mazny A, Kamal N et al. (2023, May 15). Diagnostic accuracy of ultrasound in the diagnosis of Placenta accreta spectrum: systematic review and meta-analysis. BMC Pregnancy Childbirth. 23(1): 354. https://doi.org/10.1186/s12884-023-05675-6; PMid:37189095 PMCid:PMC10186814
Peng X, Tan X, Wu Z. (2024, Dec 21). Prenatal ultrasound scoring in diagnosis and postpartum outcomes prediction for Placenta Accreta Spectrum (PAS): a systematic review. BMC Pregnancy Childbirth. 24(1): 846. https://doi.org/10.1186/s12884-024-07076-9; PMid:39709346 PMCid:PMC11662791
Shuai X, Gao C, Zhang H et al. (2024, Nov 26). Bladder involvement in placenta accreta spectrum disorders: 2D US combined with the 3D crystal Vue and MRI comparative analysis. BMC Pregnancy Childbirth. 24(1): 788. https://doi.org/10.1186/s12884-024-06997-9; PMid:39593009 PMCid:PMC11590337
Varthaliti A, Psarris A, Koutroumanis P et al. (2025, Sep 5). Prognostic Significance of Serial Ultrasonography in Placenta Accreta Spectrum and Its Impact on Perinatal Outcomes. Medicina (Kaunas). 61(9): 1612. https://doi.org/10.3390/medicina61091612; PMid:41011001 PMCid:PMC12471937
Xia H, Ke SC, Qian RR, et al. (2020, Jan). Comparison between abdominal ultrasound and nuclear magnetic resonance imaging detection of placenta accreta in the second and third trimester of pregnancy. Medicine (Baltimore). 99(2): e17908. https://doi.org/10.1097/MD.0000000000017908; PMid:31914010 PMCid:PMC6959867
Zhang J, Li H, Feng D et al. (2023, Aug 7). Ultrasound scoring system for prenatal diagnosis of placenta accreta spectrum. BMC Pregnancy Childbirth. 23(1): 569. https://doi.org/10.1186/s12884-023-05886-x; PMid:37550654 PMCid:PMC10405485
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