Ukrainian Journal of Perinatology and Pediatrics. 2025.3(103): 82-91. doi: 10.15574/PP.2025.3(103).8291
Kaminsky V. V.¹, Lakatosh P. V.², Melnik Yu. M.¹, Lakatosh V. P.³, Kostenko O. Yu.³, Dukov O. O.^2
1Shupyk National University of Healthcare of Ukraine, Kyiv
²Perinatal center of Kyiv, Ukraine
³Bogomolts National Medical University, Kyiv, Ukraine

For citation: Kaminsky VV, Lakatosh PV, Melnik YuM, Lakatosh VP, Kostenko OYu, Dukov OO. (2025). Effectiveness of ultrasound screening for pathological placentation in women with a uterine scar after cesarean section based on standard sonographic criteria. Ukrainian Journal of Perinatology and Pediatrics. 3(103): 82-91. doi: 10.15574/PP.2025.3(103).8291.
Article received: Apr 15, 2025. Accepted for publication: Sep 15, 2025.

Pathological placentation, including placenta previa (PP) and placenta accreta spectrum (PAS), is a major pregnancy complication in women with a cesarean section (CS) scar compared to normal placentation. Ultrasound with standardized sonographic criteria remains a key tool for timely detection of these conditions.
Aim – to assess the effectiveness of ultrasound screening for pathological placentation in women with a CS scar compared to NP using standard sonographic markers for early identification of PP and PAS.
Materials and methods. Between January 2020 and January 2023, 284 pregnant women with PP delivered at the Kyiv Perinatal Center. Among them, 145 had a CS scar, and 66 were suspected of PAS. Ultrasound examinations were performed using a Voluson 10 system in grayscale and color Doppler modes.
Results. In normal placentation, the “clear zone” was preserved, whereas in pathological placentation it was absent or irregular, serving as an early PAS marker. PP showed mild myometrial thinning and lacunae without abnormal blood flow, while PAS was associated with marked myometrial thinning (<1 mm), asymmetric “torn” lacunae, and turbulent blood flow. Uterine contour deformation and vesicouterine hypervascularization with bridging vessels were key indicators of deep invasion and critical for cesarean
delivery planning.
Conclusions. PAS and PP features may coexist in the same placental bed, complicating differential diagnosis. Ultrasound screening in women with a CS scar is informative when standard markers are assessed comprehensively: myometrial thinning, loss of the “clear zone”, and vascular changes allow early detection, while exophytic masses
and uterine protrusion toward the bladder identify severe PAS forms, including placenta percreta.
The investigation is consistent with the principles of the Declaration of Helsinki. The patient's information was withheld from the investigation.
The authors declare that there is a conflict of interest.
Keywords: cesarean scar, cesarean section, ultrasound, grayscale imaging, color Doppler, pathological placentation, normal placentation.

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