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CME Credit Offered
CME Credit Offered
Abstract Award
Abstract Award
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Poster Session 2

(436) Changes in Uterine, Placental metrics, and Vascularization in Placenta Left In Situ for PAS management

Thursday, January 30, 2025
4:00 PM – 6:00 PM  
Objective:

In our center, one of our placenta accreta spectrum (PAS) management approaches is leaving the placenta left in situ (LIS) for either delayed hysterectomy (6-7 weeks later), or uterine preservation. We aim to describe changes in uterine and placental metrics and vascularization in individuals with placenta LIS after delivery. We compared those with planned delayed hysterectomy or uterine preservation, to those with unscheduled hysterectomy (UH).


Study Design:

In this retrospective cohort, 32 individuals with placenta LIS were evaluated. Our management approach includes postpartum ultrasound biweekly until hysterectomy or passage of placental tissue. The individuals were divided into two groups, group I: successful planned procedure (scheduled hysterectomy or uterine preservation), group II: UH (defined as that occurring prior the scheduled date mainly due to vaginal bleeding). Measurements included: uterus length and height, and placental thickness. Directional color Doppler ultrasound was applied to evaluate the lower uterine segment using the following settings PRF= 22-25 cm/sec, medium filter, and 1.4 dB gain. Images were analyzed using Image J® software. Quantitative vascularization (QV) was defined as the percentage of pixels containing color information over the total number of pixels in the studied area. Average change per week of the mentioned parameters were calculated. Differences in metrics and QV between UH and successful conservative management were calculated.


Results:

Of 32 patients, 17 (53%) had a successful planned procedure (10 scheduled hysterectomy and 7 retained their uterus) and 15 (47%) had an UH. Differences between the two groups are presented in table 1. The reduction in uterine metrics and QV in those with successful conservative management was more pronounced, but not statistically significant.


Conclusion:

This is the first report showing longitudinal change in uterine, placental metrics and QV in those with the placenta LIS. More studies are needed to identify clinical variables which may predict successful conservative management of PAS.