Early Prediction of Placenta Accreta Spectrum in Women with Prior Cesarean Delivery Using Transvaginal Ultrasound and Color Doppler at 11 To 14 Weeks

Background: Placenta accreta spectrum (PAS) is a life-threatening obstetric condition connected with prior cesarean delivery and abnormal placental adherence. Early detection is crucial to reduce maternal morbidity and for guiding delivery planning. Although diagnosis is commonly made in the third trimester, there is growing evidence that first-trimester ultrasound may help predict PAS in high-risk women.
Objective: This study aimed to estimate the screening performance of transvaginal ultrasound (TVS) and color Doppler performed at 11–14 weeks of gestation for early expectation of placenta accreta spectrum (PAS) in women with previous cesarean deliveries.
Patients and Methods: In this prospective observational study, 63 pregnancies with one or more prior cesarean deliveries (CDs) underwent TVS and color Doppler to evaluate placental location and its relationship to the uterine scar. Patients were followed until delivery, and PAS diagnosis was confirmed surgically and histopathologically when applicable.
Results: Ultrasound demonstrated a sensitivity of 88% and a specificity of 95% in predicting PAS. Group II (those with suspicious ultrasound findings) showed significantly higher rates of histologically confirmed PAS (20%; p = 0.004), cesarean hysterectomy (44%; p < 0.001), and preterm birth (p < 0.05). Ultrasound markers such as placental lacunae, myometrial thinning, and bridging vessels were significantly associated with PAS.
Conclusion: First-trimester transvaginal ultrasound and color Doppler are effective early screening tools for PAS in women with prior cesarean deliveries, allowing timely risk stratification and multidisciplinary management to reduce maternal and neonatal complications.