Obstetrics & Gynecology · 1 h ago
Cervical-region Doppler vascularization associated with placenta accreta severity and hemorrhage
In a prospective study of 117 patients referred for suspected placenta accreta spectrum (PAS), quantitative Doppler vascularization in the anterior fornix/cervix region was associated with histopathologically confirmed PAS and severe intraoperative blood loss. A cut-off of 8.5% had 70.5% sensitivity and 89.7% specificity for PAS, but its negative predictive value was 50%.
- Prospective study included 117 patients referred for suspected PAS.
- AFC vascularization cut-off of 8.5% had 70.5% sensitivity.
- Higher vascularization was associated with severe blood loss.
- A negative result did not reliably exclude PAS.
Researchers prospectively studied 117 patients with anterior placenta previa referred for suspected PAS at a Texas center between December 2021 and June 2025. Standardized transvaginal color Doppler ultrasound was used to quantify the percentage of color pixels in the anterior fornix/cervix (AFC) region. The measurements were not provided to clinicians or used in care. PAS was confirmed by histopathology in 89 patients (76.1%); intraoperative blood loss estimates were available for 109, of whom 53 had severe blood loss (>1,500 mL).
AFC quantitative vascularization discriminated between patients with and without PAS with an area under the receiver-operating-characteristic curve of 0.821 (95% CI, 0.739–0.886). At the 8.5% cut-off, sensitivity was 70.5% and specificity 89.7%; positive and negative predictive values were 93.9% and 50.0%, respectively. Values at or above the cut-off were associated with PAS (OR 14.9), placenta percreta (OR 55.5), severe blood loss (OR 3.9), and transfusion of at least four units of blood products (OR 4.6).
The findings suggest AFC vascularization may add information for risk assessment and surgical planning in patients already referred for suspected PAS. The single-center study was conducted in a selected high-risk population, and the limited negative predictive value means a result below the cut-off cannot reliably exclude PAS. The measurements were not tested as part of clinical decision-making.
In practice
For patients with anterior placenta previa referred for suspected placenta accreta spectrum, quantitative Doppler vascularization in the anterior fornix/cervix region may provide an additional risk marker. In this prospective cohort, values of at least 8.5% were associated with PAS and severe intraoperative blood loss, but the test was not used to guide care and the negative predictive value was only 50%. The findings do not establish that the measure improves outcomes or can replace established assessment; applicability beyond this selected, single-center population is uncertain.
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Ultrasound in Obstetrics & Gynecology: Association of quantitative vascularization of the anterior fornix/cervix region with placenta accreta spectrum and associated intraoperative hemorrhage ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.