Shai Pri-Paz

Predictors of massive blood loss in women with placenta accreta

OBJECTIVE We examined predictors of massive blood loss for women with placenta accreta who had undergone hysterectomy. STUDY DESIGN A retrospective review of women who underwent peripartum hysterectomy for pathologically confirmed placenta accreta was performed. Characteristics that are associated with massive blood loss (≥ 5000 mL) and large-volume transfusion (≥ 10 units packed red cells) were examined. RESULTS A total of 77 patients were identified. The median blood loss was 3000 mL, with a median of 5 units of red cells transfused. There was no association among maternal age, gravidity, number of previous deliveries, number of previous cesarean deliveries, degree of placental invasion, or antenatal bleeding and massive blood loss or large-volume transfusion (P > .05). Among women with a known diagnosis of placenta accreta, 41.7% had an estimated blood loss of ≥ 5000 mL, compared with 12.0% of those who did not receive the diagnosis antenatally with ultrasound scanning (P = .01). CONCLUSION There are few reliable predictors of massive blood loss in women with placenta accreta.

Maximal amniotic fluid index as a prognostic factor in pregnancies complicated by polyhydramnios

Polyhydramnios is present in approximately 2% of pregnancies and has been associated with a variety of adverse pregnancy outcomes. Our aim was to evaluate the association between the maximal amniotic fluid index (AFI) and the frequency of specific adverse outcomes.

Neonatal and obstetric outcome of pregnancies conceived by ICSI or IVF

Intracytoplasmic sperm injection (ICSI) is currently widely used despite concern regarding pregnancy complications and outcome, specifically congenital malformations. The aim of this study was to compare the obstetric and neonatal outcome of pregnancies conceived by IVF and ICSI. Long-term follow-up was achieved through questionnaires sent to women who conceived after IVF/ICSI treatment. Information was obtained regarding 219 pregnancies (322 children) conceived after ICSI and 145 pregnancies (201 children) conceived after IVF. There were no significant differences between the ICSI and regular IVF pregnancies in regard to the couples characteristics and the obstetric complications. The mean +/- SD birth weight of the singletons conceived after ICSI was similar to that of singletons conceived after IVF: 3001 +/- 703 versus 3059 +/- 643 g respectively. In both groups there was a high incidence of multiple pregnancies, Caesarean sections, prematurity and low birth weights. The incidence of congenital malformations following IVF or ICSI pregnancies was similar, 6.3 and 7.7% respectively, but was increased compared with the general Israeli population. In summary, concern remains regarding the incidence of congenital malformations after IVF and the long-term outcome of ICSI pregnancies. However, the present results are reassuring with regard to the obstetric and neonatal outcome of pregnancies conceived by ICSI compared with those achieved by IVF.

Comparison between emergent and elective delivery in women with placenta accreta.

Abstract Objective: To identify possible predictive factors associated with emergent delivery of antenatally diagnosed placenta accreta and to estimate association between emergent delivery and adverse maternal outcomes in comparison to elective delivery. Methods: A retrospective study of all patients with placenta accreta diagnosed antenatally and confirmed pathologically, who were delivered between 2000 and 2010. Baseline characteristics and outcomes of emergent deliveries were compared with elective deliveries. Results: A total of 48 women met inclusion criteria, of which 24 (50%) were delivered emergently. 79.2% of emergent deliveries were preceded by antenatal bleeding (p = 0.0005), and 62.5% were preceded by recurrent bleeding (p = 0.001). Comparison of elective and emergent deliveries revealed no clinical significant difference in maternal outcome. Conclusions: Antenatal bleeding is associated with an increased risk of emergent delivery. Emergent delivery in a tertiary care facility with immediate access to blood bank and ICU capabilities does not appear to be associated with an increased risk of adverse maternal outcomes. Consequently, some patients may be candidates for delivery later than 34 weeks of gestation.

OP14.05: Evaluation of prognostic factors in pregnancies complicated by idiopathic polyhydramnios

Objectives: The limited data regarding best management for patients with vasa previa provides a challenge. The current case review was undertaken to examine the role of serial cervical length evaluation in the surveillance of these patients. Methods: This was a retrospective study of cases of vasa previa diagnosed in our obstetric ultrasound database in the past 3 years. Data regarding diagnosis, antenatal course and obstetric outcomes was collected. Results: 13 cases were reported between 2007 and 2010. Antenatal information was available in 13 patients with outcome data for the 9 patients delivering at our institution. 5/13 (38.5%) were nulliparous. 9/13 (69.2%) cases were singleton gestations and 4/13 (30.8%) multiple pregnancies. None of the patients had a previous history of preterm birth. Median gestational age at diagnosis was 18 weeks (range 12–31 weeks). 7/13 (53.8%) of the patients were diagnosed at the first US examination. Serial monitoring of cervical length was performed in the 9 cases followed at our center at variable intervals. One patient with an initial cervical length > 25 mm subsequently had a short cervix at 20 wks (17 mm). She underwent cerclage placement, then presented in preterm labor and delivered by Cesarean section at 24 weeks. Other patient admitted at 33 weeks for cervical shortening, delivered 2 days later. 3/9 (33.3%) of patients were delivered at 34 wks and 3/9 (33.3%) at 35 wks by elective Cesarean section. Bethametasone for fetal lung maturity was given in 7/9 (77.8%) of the cases. Conclusions: Vasa previa was not always recognized at the time of the first ultrasound, but diagnosis occurred in patients undergoing follow up examinations in 46% of cases. Serial measurements of the cervical length in vasa previa patients may help to identify those at risk of preterm birth that would benefit from inpatient care or earlier delivery. Further studies are needed to assess the optimal role of serial assessment of cervical length in antenatal management.

OP12.05: The effectiveness of MRI in the prenatal diagnosis of placenta accreta

Objectives: The aim of this retrospective study was to compare the accuracy of 10 commonly used weight estimation formulas in a group of fetuses with extreme macrosomia (≥ 4.500 g). Methods: Ten different formulas were evaluated in a group of 174 fetuses with a birth weight (BW) ≥ 4.500 g. Each fetus underwent ultrasound examination with complete biometric parameters within 7 days of delivery. The accuracy of the different formulas for fetal weight estimation (FWE) was compared by mean percentage error (MPE), median of the absolute percentage error (MAPE), the ‘limitsof-agreement’ method and the percentage of FWE falling within the 10% range of the true birth weight. Results: MPE was largest with the Schild formula (MPE −15.43%) and the Shepard formula (MPE 6.08%) and closest to zero with the Hadlock III formula (MPE 5.34%). The MPE of all formulas showed significant bias when compared to zero. All tested formulas, except the Shepard and Shinozuka equations, significantly underestimated fetal weight. The Hadlock III formula obtained the highest percentage of FWE within the 10% range of the true birth weight (66.3%). However, formulas estimated fetal weight in less than two thirds of cases within the 10% range of the true birth weight. Conclusions: Exact weight estimation in extreme macrosomia remains an unsolved problem questioning clinical decisions solely based on ultrasound data.