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Background <p>Postpartum hemorrhage (PPH) represents ​​one of the most frequent and serious​​ complications in placenta accreta spectrum (PAS), making prenatal risk stratification essential for optimizing obstetric management ​​strategies​​ and maternal outcomes. This study aimed to evaluate a novel prenatal ultrasound ​​method​​ for estimating ​​placenta invasion area​​ and to investigate ​​its association​​ with estimated blood loss (​​EBL in mL​​) during delivery and ​​the​​ adverse maternal outcomes ​​in PAS​​.</p> Methods <p>This a retrospective cohort study measured PAS area by determining the length of “tramline sign” obliteration and its distance from the cervical os. Placental invasion was segmented into trapezoidal sections using three-dimensional (3D)-Crystal Vue imaging. Linear and multiple regression analyses were used to assess associations between estimated PAS area and EBL, PPH (EBL ≥ 1000&#xa0;ml), severe PPH (EBL ≥ 2500&#xa0;ml) and post-delivery transfusion need.</p> Results <p>Among 168 patients, 78 developed PPH and 90 did not. The PPH group &gt; 2-fold higher PAS area vs. non-PPH (17.28 cm² vs. 7.36 cm²; <i>P</i> &lt; 0.001). Linear regression analysis indicated each 1 cm² PAS area increase corresponded to 42.84 mL higher EBL (95% CI, 27.47–55.77; <i>P</i> &lt; 0.001). PAS area independently predicted PPH (adjusted odds ratio (aOR) 1.08, 95% CI 1.04–1.13; <i>P</i> &lt; 0.001) and severe PPH (aOR 1.03, 95% CI 1.02–1.04; <i>P</i> = 0.03). ROC analysis yielded PAS area cutoffs for PPH (10.13 cm<sup>2</sup>; AUC 0.83 (0.76–0.89); <i>P</i> &lt; 0.001) and severe PPH (10.57cm<sup>2</sup>; AUC 0.83 (0.76–0.89); <i>P</i> &lt; 0.001). Using these cutoffs, PAS area outperformed classic ultrasound signs in predicting PPH and severe PPH.</p> Conclusion <p>3D-Crystal Vue-derived PAS area estimation is clinically feasible and correlates with EBL and PPH risk in PAS patients.</p>

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Crystal Vue-Estimated placental invasion area as a novel predictor of postpartum hemorrhage risk in placenta accreta spectrum disorders: a retrospective cohort study

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  • 发表日期：

    2026年1月7日

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  • Zesi Liu,
  • Peiwen Chen,
  • Dan Wang,
  • Qi Liang,
  • Qian Feng,
  • Lei Xie,
  • Ya Liu,
  • Liqun Sun,
  • Xinlin Chen

摘要

Background

Postpartum hemorrhage (PPH) represents ​​one of the most frequent and serious​​ complications in placenta accreta spectrum (PAS), making prenatal risk stratification essential for optimizing obstetric management ​​strategies​​ and maternal outcomes. This study aimed to evaluate a novel prenatal ultrasound ​​method​​ for estimating ​​placenta invasion area​​ and to investigate ​​its association​​ with estimated blood loss (​​EBL in mL​​) during delivery and ​​the​​ adverse maternal outcomes ​​in PAS​​.

Methods

This a retrospective cohort study measured PAS area by determining the length of “tramline sign” obliteration and its distance from the cervical os. Placental invasion was segmented into trapezoidal sections using three-dimensional (3D)-Crystal Vue imaging. Linear and multiple regression analyses were used to assess associations between estimated PAS area and EBL, PPH (EBL ≥ 1000 ml), severe PPH (EBL ≥ 2500 ml) and post-delivery transfusion need.

Results

Among 168 patients, 78 developed PPH and 90 did not. The PPH group > 2-fold higher PAS area vs. non-PPH (17.28 cm² vs. 7.36 cm²; P < 0.001). Linear regression analysis indicated each 1 cm² PAS area increase corresponded to 42.84 mL higher EBL (95% CI, 27.47–55.77; P < 0.001). PAS area independently predicted PPH (adjusted odds ratio (aOR) 1.08, 95% CI 1.04–1.13; P < 0.001) and severe PPH (aOR 1.03, 95% CI 1.02–1.04; P = 0.03). ROC analysis yielded PAS area cutoffs for PPH (10.13 cm2; AUC 0.83 (0.76–0.89); P < 0.001) and severe PPH (10.57cm2; AUC 0.83 (0.76–0.89); P < 0.001). Using these cutoffs, PAS area outperformed classic ultrasound signs in predicting PPH and severe PPH.

Conclusion

3D-Crystal Vue-derived PAS area estimation is clinically feasible and correlates with EBL and PPH risk in PAS patients.