Poster Session 2
.jpg "Neha Agarwal, MBBS, MD photo")
Neha Agarwal, MBBS, MD
Post doctoral Research Fellow
Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth McGovern Medical School, Houston, TX, USA
Houston, Texas, United States
Sarah T. Mehl, MD (she/her/hers)
MFM Fellow
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)
Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Dejian Lai, PhD
Professor
UT School of Public Health
Houston, Texas, United States
Gustavo Vilchez, MD, MSCR
UTHealth Houston
Houston, Texas, United States
Eleazar E. Soto, MD
Assistant Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Farah H. Amro, MD
Assistant Professor
McGovern Medical School at UTHealth Houston
Bellaire , TX, United States
Rosa Guerra, MD
Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sen Zhu, PhD
McGovern Medical School at the University of Texas
Houston, Texas, United States
Baha M. Sibai, MD
Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Sean C. Blackwell, MD
Professor and Chair
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
Ramesha Papanna, MD, MPH
Professor
McGovern Medical School at UTHealth Houston
Houston, Texas, United States
We showed that TUPAS, based on loss of uterine wall interface (LUS), arterial vascularity, and cervical involvement, can determine PAS severity based on blood loss during surgery. This study aims to validate the TUPAS in an external cohort and associate it with surgical outcomes.
Study Design:
This is a retrospective cohort study of consecutive patients referred to our center for suspected PAS from 2023-2024. Transvaginal ultrasound evaluated the LUS and cervix per predefined protocol (evaluating the placental-uterine/cervical and bladder interface with bladder half full). Patients were managed per usual clinical approach, not based on TUPAS, including c-section with placenta removal, c-hysterectomy, and conservative management. An examiner blinded to patient history and clinical outcomes retrospectively scored images/clips. Cumulative scores of 0-9 were converted to 4 categories as previously published (0: score 0; 1: score 1-3; 2: score 4-6; 3: score 7-9). The primary outcome was calculated estimated blood loss (cEBL) during the primary surgery. Secondary outcomes were surgery type, blood product transfusion, ICU admission and length of hospital stay.
Results:
86 patients were referred: 78 were included in the analysis, 6 had incomplete or no images, 2 had placenta in the upper uterine segment. Maternal demographics and number of c-section deliveries did not differ by category. Surgical management differed by category: all Cat-0 patients and 82% in Cat-1 had c-section with placenta removal (Tab 1). Cystotomy occurred only in Cat-3. From multiple linear regression analysis in log scale, Cat-3(β=0.94, p=0.002) was associated with greater blood loss than other categories, irrespective of surgery type, on multiple linear regression. C-hysterectomy in Cat-3 was associated with higher cEBL (Fig1.), requiring massive transfusion, and more severe pathology than Cat-2.
Conclusion:
Our scoring strongly associated with severity of PAS with blood loss regardless of management approach. Cat 3 represents the most severe cases; referral to a tertiary care center specializing in PAS management should be considered.
