Applicability of an ultrasound scoring system for predicting hemorrhage during cesarean section in patients with placenta accreta spectrum disorders.

OBJECTIVE: To investigate the value of an ultrasound scoring system for predicting hemorrhage during cesarean section in patients with placenta accreta spectrum (PAS) disorders. DATA AND METHODS: The ultrasound images, ultrasound scores, and clinical data of 63 patients with PAS disorders who were admitted to Maternal and Child Health Care Hospital of Shandong Province between January 2023 and August 2025 were retrospectively analyzed, subjected to univariable and multivariable logistic regression analyses, and evaluated to identify risk factors of intraoperative hemorrhage (blood loss ≥ 1000 mL) during cesarean section. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive efficacy of the ultrasound scoring system for massive hemorrhage during cesarean section in patients with PAS disorders. RESULTS: Multivariable analysis revealed that the ultrasound score was an independent risk factor for intraoperative hemorrhage during cesarean section in patients with PAS disorders (P < 0.05). Among the ultrasound scoring indicators, complete placenta previa and bridging vessels at the placental basal plate were confirmed as independent predictors of intraoperative hemorrhage (P < 0.05). ROC curve analysis revealed that in predicting massive intraoperative hemorrhage, the area under the curve (AUC) was 0.884; moreover, at a cutoff value of 7.5, the sensitivity was 80.0%, the specificity was 82.6%, the positive predictive value (PPV) was 88.9%, the negative predictive value (NPV) was 70.4%, the positive likelihood ratio (LR+) was 4.598, and the negative likelihood ratio (LR-) was 0.242. CONCLUSION: The ultrasound score is an effective tool for predicting intraoperative hemorrhage during cesarean section in PAS patients. Complete placenta previa, bridging vessels at the placental basal plate, and a score ≥ 7.5 are important risk factors. Accurate identification of these factors is helpful for stratifying patients preoperatively, optimizing surgical preparation, and improving clinical decision-making.