Oral Concurrent Session 1 - Medical and Surgical Complications of Pregnancy
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
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
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
The increase in uterine vascularity in patients with placenta accreta spectrum (PAS) may be reflected in the uterine arteries(UtA). We aim to identify if there are differences in UtA Doppler indices in patients with and without PAS, and if these indices can predict PAS severity.
Study Design:
This was a prospective cohort of 136 patients referred to an academic referral center for suspected PAS. Following referral, patients were deemed to either be low-risk or high-risk for PAS based on ultrasound imaging. At the time of referral, the left and right UtA were evaluated (~1cm from crossing with external iliac artery, wall filter 90Hz, angle of insonation close to 0), and mean values of the peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI) were calculated. Mean values were converted to z-scores to adjust for differences in gestational age. PAS diagnosis and severity were confirmed by pathology following hysterectomy. Comparisons were made to previously published reference values for the UtA in uncomplicated pregnancies. Differences in Doppler indices were analyzed using Student’s t-test and ANOVA with post-hoc tests.
Results:
Sixty-three out of 136 (46.3%) patients did not have PAS. 73/136 (53.7%) patients had PAS and underwent hysterectomy. Of these, 17/73 (23.3%) had accreta, 40/73 (54.8%) had increta, 16/73 (21.9%) had percreta.
Mean PI was similar in patients with PAS compared to normal reference values; PSV and EDV were higher in patients with PAS. (Fig.1)
Mean z-PI was not significantly different between patients with (mean 0.23, SD 0.9) or without PAS (mean 0.19, SD 1.02), p=0.87. Mean z-PSV and z-EDV were significantly higher in women with PAS (PSV mean 7.05, SD 3.1; EDV mean 1.35, SD 3.4) compared to those without PAS (PSV mean 4.15, SD 2.9, p< 0.001; EDV mean 0.53, SD 1.4, p=0.007). (Fig.2) No differences in z-PI, z-PSV, or z-EDV were seen based on PAS severity.
Conclusion:
In those with PAS, UtA Doppler indices are not different based on the degree of placental invasion. However, UtA PSV and EDV are higher in patients with PAS compared to those without PAS.