Intracervical lakes as a novel sonographic potential marker for placenta accreta spectrum: a prospective...

Placenta accreta spectrum (PAS) is a major cause of obstetric hemorrhage and maternal morbidity. Accurate antenatal prediction is vital for surgical planning. Conventional ultrasound markers such as placental lacunae and myometrial thinning have limited specificity. Novel markers, including intracervical lakes (ICL) and absence of the cleavage line, may improve diagnostic accuracy.

A prospective observational study was conducted at Minia University Maternity Hospital (March 2024-February 2025). A total of 150 women with placenta previa were enrolled and classified by intraoperative blood loss: < 2500 mL (n = 86) and ≥ 2500 mL (n = 64). All underwent standardized preoperative ultrasound evaluation, including traditional and novel markers. Intraoperative findings were the reference standard.

Massive bleeding occurred in 64 women (42.7%) who required longer operative times, more transfusions, and had higher rates of hysterectomy (18.8% vs. 0%) and bladder injury (60.9% vs. 12.8%) than controls (all p < 0.001). Traditional ultrasound signs showed only moderate accuracy; lacunae grade > 2 had 88% sensitivity, 53% specificity, and an AUC of 0.78. In contrast, ICL achieved 97% sensitivity, 98% specificity, and an AUC of 0.99 (95% CI 0.94-1.00). Absence of the line of cleavage also performed well (96% sensitivity, 85% specificity, AUC = 0.90). Neonatal outcomes did not differ significantly (p > 0.05).

Novel ultrasound markers, especially ICL and the absence of the cleavage line, provide superior accuracy for predicting PAS and massive bleeding in placenta previa. Incorporating these signs into routine assessment can improve risk stratification, surgical preparedness, and reduce maternal morbidity.