Prediction of Postpartum Hemorrhage by Sonographic Uteroplacental Morphology in Placenta Previa

The aim of this study was to determine the effect on the amount of hemorrhage in placenta previa of the size and number of lacunae and the thickness of the myometrial tissue below the placenta at the thinnest part. A total of 58 patients with placenta previa were separated into two groups according to the presence or not of placental lacunae. The number of lacunae, the size of the lacuna with the maximum diameter, and the thickness of the myometrial tissue below the placenta at the thinnest part were measured. The patients were delivered by cesarean section between the 36th and 38th weeks. The operating time, decrease in hemoglobin level, and the need for additional surgical procedures were recorded. The myometrial thickness below the thinnest placental part was lower in the group without lacunae, but not statistically significant. The need for additional surgical intervention during the operation was higher in patients with placental lacunae. The number of lacunae, the size of the largest lacuna, and the thinnest myometrial thickness could statistically significantly predict hemoglobin change (p = 0.025, p<0.001, and p<0.001, respectively), and these variables accounted for 68.1% of the explained variability in hemoglobin change. The maximum lacuna size and the thinnest myometrial thickness could statistically significantly predict average surgery duration (p<0.001 and p<0.001, respectively), and these variables accounted for 72.3% of the explained variability in average surgery duration. In conclusion, the size and number of the lacunae or the thickness of the myometrial tissue below the placenta at the thinnest part can be used to predict the decrease in hemoglobin levels and the operating time in patients with placenta previa totalis, which will enable optimal necessary preoperative measures to be taken.