In placenta praevia, which combination of ultrasound findings predicts the HIGHEST likelihood of requiring cesarean hysterectomy for placenta accreta spectrum?

• A Grade III posterior praevia with uterine contraction artefact
• B Low-lying placenta (edge 1–2 cm from os) with Grade I changes
• C Complete praevia with no prior uterine surgery
• D Anterior praevia with previous cesarean scar, lacunar spaces on B-mode, and loss of retroplacental clear space ✓

Explanation

The combination of anterior placenta praevia overlying a previous cesarean scar, along with ultrasound findings of multiple lacunar spaces ('moth-eaten' appearance or 'Swiss cheese' pattern), loss of retroplacental clear space, and bridging vessels to the bladder are the strongest predictors of placenta accreta spectrum (PAS). MRI and Doppler may be added for further assessment. This combination mandates delivery planning at a specialist centre with interventional radiology and blood bank support.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.