Poster Session 4
Category: Clinical Obstetrics
Poster Session 4
Sarah E. Miller, BS, MD
Fellow
Brigham and Women's Hospital
Boston, Massachusetts, United States
Rishi B. Chopra, BS (he/him/his)
Clinical Research Coordinator
Brigham and Women's Hospital
Fremont, California, United States
Hope Y. Yu, MD
Maternal-Fetal Medicine Physician
Department of Obstetrics and Gynecology, MassGeneral Brigham; Division of Maternal-Fetal Medicine; Harvard Medical School
Bostton, Massachusetts, United States
Ved Topkar, BS, MD, PhD
Resident
Brigham and Women's Hospital
Boston, Massachusetts, United States
Nicola Perlman, MA, MD
University of California San Francisco
San Francisco, California, United States
Daniela A. Carusi, MD, MSc (she/her/hers)
Associate Professor
Department of Obstetrics and Gynecology, MassGeneral Brigham; Division of Maternal-Fetal Medicine; Harvard Medical School
Boston, Massachusetts, United States
Uterine conservation for placenta accreta spectrum (PAS) may involve placental retention to avoid placental extraction morbidity which often confers an increased risk of delayed hemorrhage and infection. We describe a cohort of suspected lower-grade PAS patients managed with planned placental removal and availability of uterine artery embolization (UAE) compared to planned hysterectomy.
Study Design:
Between 2016-2024 a cohort of patients with radiographic suspicion of low-grade PAS (lacked signs of Percreta/Grade 3 PAS) underwent conservative management with availability of UAE at a single tertiary hospital. Outcomes were compared to those with similar radiologic and clinical criteria who underwent planned hysterectomy without placental removal. Those with singleton pregnancies >24w GA with clinically confirmed PAS were analyzed.
Results:
We identified 73 eligible patients, 18 planning conservative management (CM) and 55 undergoing planned hysterectomy (PH). Demographics were similar between groups aside from parity, prior c-sections and BMI (Table 1). Delivery outcomes (Table 2) were similar including hemorrhage requiring RBC transfusion ³4 units, procedure times and general anesthesia use. There were no delayed hysterectomies or readmissions for infection in the CM group. The placenta was entirely removed in 78% of CM cases and partially removed during delivery in 17% of CM and 29% of PH cases (p< 0.01). Uterine retention was successful in 89% of CM cases with UAE performed in 67% of cases. Six of 18 CM patients (33%) had at least one subsequent pregnancy, 83% of which resulted in a viable birth. Rates of recurrent hemorrhage and PAS were both 67%, and there was one hysterectomy.
Conclusion:
In patients with radiographically suspected lower-grade PAS, uterine conservation with placental removal was successful in 89% of clinically confirmed PAS patients with 67% having peri-delivery UAE. Delivery outcomes were similar when compared to hysterectomy. Antenatally planned peripartum embolization may facilitate the safe execution of uterine conservation with placental removal in a subset of PAS patients.