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Ultrasound Obstet Gynecol. 2019 Sep 10. doi: 10.1002/uog.21866. [Epub ahead of print]

Intracervical lakes as a sonographic marker of placenta accreta spectrum (PAS) in patients with previa and low-lying placenta.

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Department of Obstetrics and Gynecology, University of Parma, Parma, Italy.
Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy.
Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway.
Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Science, Uit- The Arctic University of Norway, Tromsø, Norway.
Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy.



Prenatal diagnosis of Placenta Accreta Spectrum (PAS) has been associated with reduced maternal morbidity. The introduction of new imaging signs is crucial in identifying women affected by this condition. The aim of our study is to evaluate the diagnostic accuracy of a new ultrasound sign, which it has been named "intracervical lakes", in predicting presence and outcome of PAS disorders.


retrospective multicentric study conducted in three Italian tertiary units from January 2015 to September 2018 including all women with placenta previa. The primary aim was to explore the diagnostic accuracy of intracervical lakes in detecting the presence and the depth of PAS disorders. The secondary aim was to explore the accuracy of this sign in predicting the following clinical outcomes: total estimated blood loss; antepartum bleeding; post-partum haemorrhage at the time of Caesarean Section; need for Caesarean hysterectomy. Diagnostic accuracy was assessed computing summary estimates of sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratios (DOR).


332 women were included in the analysis with a median maternal age of 33.0 (29.0-27.0). Intracervical lakes were noted in 15.1% of overall patients with placenta previa. At logistic regression analysis, intracervical lakes were independently associated with major post-partum haemorrhage (OR 3.3; 95% CI 1.6-6.5; p<.001), hysterectomy (OR 7.0; 95% CI 2.1-23.9; p<.001), placenta percreta (OR 2.8; 95%CI 1.3-5.8; p<.01). Compared to the group with placenta previa without ultrasound signs of accretism, the association of at least one "typical" sign and intracervical lakes had an OR of 217.2 (95% CI 27.7-1703.4; p<.001) for placenta percreta and of 687.4 (95% CI 121.4-3893.0; p<.001) for Caesarean hysterectomy.


Intracervical lakes may represent a marker of deep villus invasiveness in women with suspected PAS at antenatal sonography and anticipate the occurrence of severe maternal morbidity. This article is protected by copyright. All rights reserved.


Caesarean Hysterectomy ; Parametrial Invasion; Percreta ; Placenta Accreta spectrum ; Ultrasound


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