Prognostic Significance of Serial Ultrasonography in Placenta Accreta Spectrum and Its Impact on Perinatal Outcomes

Abstract

Placenta accreta spectrum (PAS) disorders remain a major cause of maternal morbidity and adverse perinatal outcomes due to abnormal placental adherence and invasion. Early and accurate prenatal diagnosis is essential to optimize surgical planning and reduce complications. Although ultrasound is well established as the cornerstone for PAS detection, the potential role of serial ultrasonography in refining risk assessment and predicting outcomes is increasingly being explored. Monitoring with serial ultrasonographic imaging may offer valuable insights into the progression of sonographic features, such as placental lacunae, myometrial thinning, placental bulge, and bladder wall disruption, which can predict surgical complexity and perinatal risk and influence decision-making and management. However, there is still limited evidence about the prognostic value of serial scans, and the variability in interpreting ultrasound markers continues, presenting challenges. While scoring systems incorporating ultrasound features show promise for risk stratification, further validation in larger studies is needed. Future research should focus on standardizing ultrasound protocols, validating predictive models, and exploring technological innovations, including artificial intelligence, to enhance diagnostic precision. Incorporating serial ultrasound assessments thoughtfully into clinical practice may improve individualized care and outcomes for women affected by PAS, but more studies are required.