Hussein, Ahmed M;
Fox, Karin;
Bhide, Amar;
Elbarmelgy, Rasha A;
Elbarmelgy, Rana M;
Thabet, Mohamed M;
Jauniaux, Eric;
(2023)
The impact of preoperative ultrasound and intraoperative findings on surgical outcomes in patients at high-risk of placenta accreta spectrum.
BJOG: An International Journal of Obstetrics and Gynaecology
, 130
(1)
pp. 42-50.
10.1111/1471-0528.17286.
Preview |
Text
BJOG-22-0599R1 Accepted MS.pdf - Accepted Version Download (1MB) | Preview |
Abstract
OBJECTIVE: To assess whether preoperative ultrasound imaging and intraoperative features predict surgical outcomes in patients at high-risk for placenta accreta spectrum (PAS). DESIGN: Cohort study. SETTING: Cairo University Maternity, Egypt. POPULATION OR SAMPLE: Pregnant patients with one or more prior cesarean delivery presenting with a low-lying/placenta previa with or without PAS confirmed by histopathology. METHODS: Logistic regression and multivariable analyses. MAIN OUTCOMES MEASURES: Need for primary cesarean hysterectomy, numbers of red blood cell (RBC) units transfused and patients requiring transfusion of > 5 units. RESULTS: Ninety consecutive records were reviewed including 58 (64.4%) PAS cases. Sixty (66.7%, 95%CI 56-76%) required hysterectomy. Odds of hysterectomy were significantly (P=.005) increased with complete previa. Significantly higher odds of hysterectomy were associated with subplacental hypervascularity (7.23, 95% CI 2.72;19.2, P<.001), lacunar scores 2+ and 3+ (12.6, 95% CI 4.15;38.5) P<.001), lacunar feeder vessels (5.69, 95% CI 1.77;18.3, P=.004) or bridging vessels (2.00, 95% CI 1.29;3.10, P=.002) on ultrasound, and increased lower segment vascularization at laparotomy (5.42, 95% CI 2.09;14.1, P=.001). Transfusion > 5 RBC units was associated with number of lacunae (OR 1.48, 95% CI 1.14;1.93, P=.004) and presence of feeder vessels (OR 1.62, 95% CI 1.24;2.11, P=.001). The multivariable analysis indicated that parity, placental location and PAS were significantly (P=.007; P=.01; P<.001, respectively) associated with hysterectomy. CONCLUSIONS: Preoperative ultrasound imaging can assist in triaging and counselling patients regarding the odds of PAS, intraoperative blood losses and need for hysterectomy whereas intraoperative features can assist the surgeon in evaluating the need for multidisciplinary support.
| Type: | Article |
|---|---|
| Title: | The impact of preoperative ultrasound and intraoperative findings on surgical outcomes in patients at high-risk of placenta accreta spectrum |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/1471-0528.17286 |
| Publisher version: | https://doi.org/10.1111/1471-0528.17286 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Placenta accreta spectrum, increta, percreta, ultrasound, uterine dehiscence |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Reproductive Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10157073 |
Archive Staff Only
 |
View Item |
