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Poster Session 2

Category: Ultrasound/Imaging

Poster Session 2

(589) The Development of Placenta Accreta Spectrum-Sonographic Assessment for Forecasted Estimated Blood Loss (PAS-SAFE) Scoring System

Wednesday, February 11, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Maya A. Sahtout, BS (she/her/hers)

Medical Student
UC Davis School of Medicine
Sacramento, California, United States

Coauthor(s)

CG

Chitra Gotluru, MD

MFM Fellow
University of Miami/ Jackson Health System
Miami, Florida, United States
AD

Amberly Diep, MD

Resident
Department of Obstetrics and Gynecology, UC Davis
Sacramento, California, United States
DS

Debra Swanson, MD

Physician
Department of Obstetrics and Gynecology, UC Davis
Sacramento, California, United States
HH

Herman Hedriana, MD

Physician
Department of Obstetrics and Gynecology, UC Davis
Sacramento, California, United States
Lihong Mo, MD, PhD

Physician
Department of Obstetrics and Gynecology, UC Davis
Sacramento, California, United States

Objective:
While the sonographic diagnostic criteria for Placenta Accreta Spectrum (PAS) were well established, they do not reliably predict the degree of intraoperative hemorrhage. The objective of this study is to develop and validate a PAS-Sonographic Assessment for Forecasted Estimated Blood Loss (PAS-SAFE) scoring system, thereby enhancing preoperative planning.

Study Design:
A retrospective cohort of 113 patients confirmed PAS at a single tertiary academic medical center was identified (2015 to 2024). Patients were excluded if data were incomplete, EBL values were outliers, or if pregnancy was terminated. The final cohort included 30 patients, with 17 classified as low EBL (≤ 1,000 mL) and 13 as high EBL ( > 3,000 mL). Second- or third-trimester ultrasounds were independently reviewed by four blinded examiners. Each examiner assigned a PAS-SAFE score. Inter-rater reliability was assessed using intraclass correlation coefficients. Linear regression assessed the association between PAS-SAFE score and EBL, with R² and p-value reported.

Results:
The PAS-SAFE scoring system consisted of six components (Figure 1) including lacunae, placenta location, previa status, vascularity, bladder involvement, and blood flow. Inter-rater reliability was 16.67% however the trend was similar between examiners (Figure 1). There was a significant correlation between the PAS-SAFE score and the EBL at cesarean hysterectomy (Figure 2). Confounding variables including hypertension, gestational age at delivery, antenatal vaginal bleeding episodes, number of prior cesarean sections, and urgency of delivery were found to be similar between groups.

Conclusion:
The PAS-SAFE scoring system shows promise as a predictive tool for estimating blood loss at the time of cesarean hysterectomy in patients with PAS. Limitations of this study include the small sample size of both patients and examiners, which may impact generalizability. Future directions include prospective validation of the scoring system in larger, multi-center cohorts to assess its clinical utility and reproducibility across diverse practice settings.