Oral Concurrent Session 6 - Ultrasound and Genetics
Oral Concurrent Sessions
Elias Kassir, MD (he/him/his)
MFM Fellow
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Donatella Gerulewicz, MD
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
.jpg "Sarah T. Mehl, MD (she/her/hers) photo")
Sarah T. Mehl, MD (she/her/hers)
MFM Fellow
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Farah H. Amro, MD
Assistant Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Eleazar E. Soto, MD
Assistant Professor
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
Ramesha Papanna, MD, MPH
Professor
University of Texas Health Science Center in Houston, McGovern Medical School
Houston, Texas, United States
Sean C. Blackwell, MBA, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Baha M. Sibai, MD
Professor
Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
We aim to determine if a novel technique for quantification of vascularity in the anterior fornix/cervix (AFC) on ultrasound (US) images can be used to predict placenta accreta spectrum (PAS) severity and intraoperative blood loss (IOBL) at time of cesarean hysterectomy (CH).
Study Design:
Prospective cohort of 42 patients with suspected PAS and anterior placenta previa. On transvaginal US done at time of referral, the AFC was defined as a triangle formed by 1) a line following the endocervical canal, 2) a second line from the internal os following the contour of the placenta until its deflexion, 3) a third line from the placental deflexion to the external os (Fig.1). Fixed color Doppler settings were applied: PRF 2.5-3.4kHz, low wall motion filter, gain 0.2dB. Quantitative vascularization (QV) was the percentage of pixels with color Doppler signals within the AFC, estimated with a MatLab® algorithm. Analyses compared QV with placental invasion (ANOVA, post-hoc tests), and between patients with and without IOBL >1500mL at time of CH (Student’s t-test). ROC analysis was done for IOBL >1500mL.
Results:
Twelve out of 42 patients were found to not have PAS. 30/42 had PAS and underwent CH: 10 had accreta, 11 increta, and 9 percreta. An increase in QV with worsening PAS severity was seen (mean±SD): no PAS (4.7%±3.9%), accreta (12.3%±12.9%), increta (18.5%±15.9%), and percreta (32.7%±19.5%), p< 0.001 (Fig2a). Patients with IOBL >1500mL (n=9) had higher QV (mean±SD) (27.5%±17.3%) than those with IOBL≤1500mL (n=21) (8.7%±11.6%), p< 0.01 (Fig2b).
Area-under-ROC-curve to predict IOBL>1500mL was 0.83 (95%CI 0.69-0.93, p< 0.0001). When QV≥20% the odds ratio for IOBL>1500mL was 7.91 (95%CI 1.31-47.5; p=0.02); sensitivity 80%, specificity 75%, PPV 57.8%, NPV 89.7%.
All patients without PAS had QV< 20%. However, 8/10 patients with accreta, 6/11 with increta, and 2/9 with percreta also had QV<20%.
Conclusion:
Increased QV in the AFC is associated with greater severity of PAS and increased IOBL at time of CH. In patients with QV≥20%, consideration may be given to measures to mitigate bleeding at the time of delivery.