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THE VALUE OF THE “INTRACERVICAL LAKES” SIGNS ON TRANSVAGINAL ULTRASOUND IN PATIENTS WITH PLACENTA ACCRETA SPECTRUM
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Abstract
Objective: An evaluation of the diagnostic and surgical prognostic significance of the ‘’ Intracervical lakes (ICL)’’ sign in patients with placenta accreata spectrum (PAS). Methods: This prospective descriptive study investigated into 40 patients diagnosed with PAS at the National Hospital of Obstetrics and Gynecology between January 1st, 2024, and December 31st, 2024. All patients underwent transvaginal ultrasound to assess for the presence of the ICL sign. The primary objective was to evaluate the accuracy of the 'intracervical lakes' sign in diagnosing placenta accreta spectrum and in predicting surgical outcomes, including: hysterectomy, uterine preservation, the volume of blood transfusion required, and the duration of the surgical procedure. Results: 40 patients preoperatively diagnosed with placenta accreta spectrum (PAS) exhibiting the ICL sign on transvaginal ultrasound were included and subsequently confirmed by postoperative histopathological findings. The mean age of the patient cohort was 34.4 years. Notably, all patients with PAS had a history of at least one prior cesarean section. The odds ratio for requiring hysterectomy was 8.4 times higher in patients with Grade 2 ICL compared to those with Grade 1 ICL (OR 8.4, 95% CI: 1.27-55.39); this ratio increased to 18.2 in patients with Grade 3 ICL (OR 18.2, 95% CI: 1.76-188.07). Furthermore, the surgical duration in the Grade 3 ICL group was 1.4 times longer than in the Grade 1 ICL group (p=0.016). The mean volume of blood transfusion was nearly threefold higher in patients with Grade 3 ICL compared to those with Grade 1 ICL, and almost double that of patients with Grade 2 ICL (p=0.016). Conclusion: Our study has demonstrated that the degree of increased conspicuity of lower uterine segment vessels/intracervical lakes (ICL) has a significant impact on several critical intraoperative factors, including surgical duration, blood transfusion volume, and the rate of uterine preservation.
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Keywords
Placenta previa, placenta accreta spectrum, intracervical lakes, transvaginal ultrasound, hysterectomy, uterine preservation in placental acreta spectrum.
References
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