P30.09: Correlation between STIC Power Doppler impedance indices from spherical samples of the placenta and conventional umbilical artery Doppler indices in normal pregnancies

Abstract

Objectives: The objective of the study was to evaluate differences in post partum bleeding, transfusion requirement and length of hospital stay in women with focal vs. diffuse placenta accreta. The same parameters were compared in women undergoing balloon occlusion vs. no occlusion of the iliac arteries at Caesarean delivery for accreta. Methods: Prospective observational study of women with suspected focal or diffuse placenta accreta on routine sonography. Follow up scans were performed as required. Surgical and histologic correlation was performed after Caesarean delivery. Independent groups t-tests and non-parametric Mann-Whitney U were used in the statistical analysis. Results: 25 women were diagnosed on ultrasound with placenta accreta, 9 with focal accreta and 16 with diffuse involvement. On average, women in the diffuse group exhibited significantly greater blood loss (P < 0.001) than the focal group and had a higher transfusion requirement (P = 0.12). There was no significant difference in hospital stay between the groups. 12 women underwent balloon iliac occlusion at Caesarean delivery, 2 of whom had focal accreta diagnosed prenatally and 10 had diffuse accreta. There were no significant differences in blood loss, transfusion requirement or length of hospital stay between the balloon vs. no-balloon occlusion groups. Conclusions: Prenatal diagnosis of extent of placenta accreta is clinically important and should guide management around delivery. Although the numbers in this study are small, no significant differences in blood loss or transfusion requirement were observable between the balloon occlusion vs. no occlusion group. Further studies are required to assess whether this is a worthwhile and cost-effective intervention in management of placenta accreta.