165: Conservative management of placenta accreta

Abstract

Tsz Kin Lo, Wai Lam Lau, Wing Cheong Leung Kwong Wah Hospital, Obstetrics & Gynecology, Hong Kong, China OBJECTIVE: To review and share our experience in conservative management of placenta accreta during cesarean delivery. STUDY DESIGN: From 2006, cesarean delivery in our unit for cases high risk for accreta (placenta previa with either uterine scar, sonographic evidence of accreta, or both) followed a proforma, which included insertion of femoral sheaths by radiologist before operation, classical cesarean section if necessary to avoid placental incision, leaving behind adherent part of placenta should it fail to separate, followed by uterine artery embolization (UAE) and/or other appropriate hemostatic measures. Postpartum, 2-week antibiotics was given. Cases managed this way with accreta confirmed intra-operatively were included in this review. The clinical details were retrieved from the case notes for individual cases. RESULTS: A total of 12 cases of accreta had the adherent part of their placenta left behind during caesarean section. (Table) Absence of sonographic features of accreta was not associated with smaller extent of placental retention or less intra-operative blood loss. Those with 50% of placenta left behind due to lack of separation from placental bed had lower risk of heavy bleeding intra-operatively compared to those with 50% of placenta retained (bleeding 3000ml: 14% vs 60%, significant clinically although statistically p 0.222) but higher chance of passing placental tissue postpartum (passage rate 71% vs 0%, p 0.028) The extent of placenta left behind, while not affecting the timing of menstrual return, correlated positively with the time taken for sonographic resolution of retained placenta (p 0.012). CONCLUSION: It’s our experience that in high risk cases (major placenta previa with uterine scar), sonographic features have relatively low sensitivity for accreta. A dedicated proforma to leave accreta untouched intra-operatively allows high risk cases to be delivered safely. The postpartum course is favorable. 166 The peri-partum period is characterized by a major alteration in brain neurotransmitters levels–a possible connection to postpartum depression Yael Hants, Yosefa Avraham, David Mankuta, Lia Vorobeiv, Shira Merchavia, Eithan Galun, Elliot Berry, Sagit Arbel-Alon Hadassah Hebrew University Medical Center, Obstetrics & Gynecology, Jerusalem, Israel, Hadassah Hebrew University Medical Center, Goldyne Savad Institute of Gene Therapy, Jerusalem, Israel, Hadassah Hebrew University Medical Center, Clinical Nutrition, Jerusalem, Israel OBJECTIVE: Postpartum depression (PPD) which affects 10% to 15% of pregnant women is detrimental to both mother and child. The mechanisms of PPD development are poorly understood. It was recently shown that the placenta is the source of fetal brain serotonin levels and essential for normal fetal brain development. This observation raised a thought that the placenta could also affect maternal serotonin levels, and that upon delivery, major abrupt serotonin level changes take place that may lead to PPD. In this study we investigated the levels of brain serotonin and catecholamines at different stages of pregnancy including midpregnancy, prepartum and postpartum periods. STUDY DESIGN: We monitored the levels of brain catecholamines, serotonin and their metabolites of 48 BALB/C mice, 12 weeks old which were divided into five experimental groups: control (10 mice, not pregnant), on days 11, 16 and 19 of pregnancy (11 mice each group) and one week postpartum (5 mice). The levels of serotonin, tryptophan, norepinephrine and dopamine were assessed in the hypothalamus, hippocampus, and striatum performed by HPLC-ECD and GC-MS while the assessment of 5HT1A message levels were performed by Real Time PCR. Characteristics of 20 cases of PPH