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CME Credit Offered
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Abstract Award
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Poster Session 3

(909) Prevalence of Undiagnosed Placenta Accreta Spectrum After Unplanned Postpartum Hysterectomy

Friday, January 31, 2025
10:30 AM – 12:30 PM  

    Submitting Author and Presenting Author(s)

  • Sarah T. Mehl, MD (she/her/hers)

    MFM Fellow
    McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

    • Coauthor(s)

  • AZ

    Abigail S. Zamorano, MD

    Assistant Professor
    Division of Gynecology Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Health Science Center in Houston, McGovern Medical School
    Houston, Texas, United States

  • Beatrice Valentini, MD

    Resident
    University of Parma
    University of Parma, Emilia-Romagna, Italy

  • ZD

    Zakaria Doughan, MD

    Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at UTHealth Houston
    Houston, Texas, United States

  • Elias Kassir, MD (he/him/his)

    MFM Fellow
    University of Texas Health Science Center at Houston, McGovern Medical School
    Houston, Texas, United States

  • Edgar A. Hernandez-Andrade, MD, PhD (he/him/his)

    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

  • Baha M. Sibai, MD

    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

Objective:

Antenatal diagnosis of placenta accreta spectrum (PAS) is crucial for maternal counseling and surgical planning. There is minimal data describing frequency of missed diagnosis of PAS by ultrasound, particularly in those without risk factors. Our objective was to identify rate and reason of undiagnosed PAS in unplanned postpartum hysterectomy.

Study Design:

A retrospective cohort study of pregnancies resulting in unplanned postpartum hysterectomy from 2019 – 2024 and delivered within our institution’s hospital system. Pregnancy outcomes were evaluated in two groups: PAS and no PAS. Maternal characteristics, pre-existing risk factors for PAS, antenatal ultrasound findings, and outcomes including PAS severity by pathology were analyzed.

Results:

A total of 45 unplanned postpartum hysterectomies were reviewed. All but 1 patient had prenatal care. PAS by pathology was identified in 14 (31%) patients. Table 1 describes characteristics including prior uterine surgery and placenta previa. Similar risk factors were seen between those with PAS and without. Among the 14 cases of PAS, 11 (79%) did not have placenta previa, 8 (57%) did not have prior CD, and 5 (42%) did not have anterior placenta. All 8 cases without prior CD also did not have placenta previa yet had PAS. Table 2 further describes additional risk factors among those with PAS. Accreta was the most common pathology finding, seen in 10 (71%) cases.

Conclusion:

In this cohort, approximately 30% of unplanned postpartum hysterectomies were due to PAS. Routine risk factors such as previa and prior CD were not present in 57% of cases. Our findings suggest a need for detailed placental evaluation for all pregnant women regardless of prior uterine surgery or previa.