P 25.07: Placenta previa: incidence, risk factors and outcome

Abstract

Electronic poster abstracts Results: We have evaluated 420/312/208 women after 6 weeks/6 months/1 year; the average age was 31.4; SD ± 4.15; BMI 23.3; SD ± 4.5; pregnancy week 40.17; SD ± 1.26. Hysterotomy suture was closed in a single layer in 46,1 % of the cases and in two layers in 53,9 % of the cases. A wall defect was found in 79,5 %; 77,8% and 82% respectively. This mostly involved inclusive cysts and fissures out of contact with the uterine cavity (73.8 %). On the average, the scar was situated 30.2 mm from the external orifice; SD ± 6.6 mm; 10.13 mm from the internal orifice; SD ± 2.5 mm; and 50.3 mm from the fundus of the uterus; SD ± 8.3 mm. The myometrium is 12.16 mm high above the scar; SD ± 2.8 mm and 11.2 mm high under the scar; SD ± 2.6 mm. During the period from the 6th week to the 1 year, the position of the uterus changed from retroversion to anteversion in 9 % of the cases. When we compared Caesarean sections performed on a fully dilated orifice and other findings, we did not find any significant correlation, except for the parameters of the location of the scar from the external orifice of the uterus and the fundus of the uterus and the height of myometrium above the defect (independent sample T-Test). Conclusions: 6 weeks after the Caesarean section marked wall defects are apparent. Mostly seen defect after 6 weeks are inclusive cysts after 1 year is a typical niche. We have not found any significant difference between a uterine wall defect and hysterotomy suture in a single layer or two layers. Problems like bleeding and pain we found only in 4,5% of women. P25.07 Placenta previa: incidence, risk factors and outcome Objectives: Placenta previa is frequently associated with severe maternal bleeding leading to an increased risk for adverse outcome of mother and infant. Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta previa. Methods: Data were prospectively collected from patients diagnosed with placenta previa at 10 Austrian hospitals in the province of Styria between 1993 and 2012. Outcome parameters were risk factors , maternal and neonatal outcome. Differences between women with major placenta previa (complete or partial placenta previa) and minor placenta previa (marginal placenta previa or low-lying placenta) were evaluated. Results: 328 patients with placenta previa were identified. The overall incidence of Placenta previa was 0.44%, with increasing rates from 0.36% to 0.54% during the study period. The most frequent risk factors included prior uterine surgery (49%), maternal age > 35 years (29.3%), multiparity (57%), prior Caesarean delivery (22.8%), recurrent abortions (22.8%), and history of placenta previa (10.8%). Maternal morbidity was high (antepartum bleeding 42.3%, postpartum hemorrhage 7.1%, maternal anemia 30%, comorbid adherent placentation 4%, and hysterectomy 5.2%). Neonatal complications included preterm birth (54.9%), low birthweight (<2500 g: 35.6%), Apgar-score after 5 minutes < 7 (5.8%) and fetal mortality (1.5%). Women with major placenta previa had a significant higher incidence of preterm delivery (OR = 6.04, CI 3.27-11.15, p < 0.01), birthweight < 2500 g (OR = 3.82, CI 2.05-7.11, p < 0.01) and Apgar-score after 5 minutes < 7 (OR = 6.39, CI 1.35-30.35, p < 0.01). Conclusions: The incidence of placenta previa was 0.44% and increased, equally to the number of Caesarean deliveries, about 50%. Placenta previa is associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. Therefore, detection and prevention of risk factors is important to ultimately improve maternal and fetal outcome. Objectives: To evaluate the CSDs (Caesarean scar defects) in women who underwent an elective or repeat Caesarean section, to compare three different types of suture (single-layer; double-layer; single or double layer with additional interrupted stitches or only interrupted stitches) and to correlate the CSDs to the distance from the os. Methods: We conducted a longitudinal observational cohort study which included women with singleton pregnancies who underwent a first or iterative Caesarean delivery (Joel-Cohen uterotomy) performed by an expert surgeon in our Prenatal Medicine Unit between October 2009 and July 2012. Were excluded women with Type 1 diabetes, connective disorders, previous myomectomy, myomas in the anterior lower segment of the uterus, uterine malformations. After 12 months all the women enrolled underwent a clinical examination and sonographic assessments which especially evaluated CDSs and RMT (residual myometrium thickness). Statystical analysis was conducted by means of student t-test, linear and multivariable regression. Results: Ninty-seven cases were enrolled in the present study. No evidence of association between single or double layer closure and larger CSDs was noted. Moreover, no larger volume niche was reported when interrupted sutures or single or double layer with additional interrupted stitches was performed. In multivariable analysis the distance from the os and the deficiency ratio <50% (the ratio between the residual endometrium on the total contigous endometrium) were positively and indipendentely associated with the volume of the isthmocele. Conclusions: Out of all the possible associations with CDS, we reported a significant association between the distance from the OS and the deficiency ratio with isthmocele. P25.09 Objectives: The aim of this study was to evaluate the performance of ultrasound in prenatal diagnosis of invasive placentation and to explore the role of ultrasound signs in predicting disorders of invasive placenta. Methods: Antenatal cases of placental previa were collected retrospectively in a single site tertiary delivery center. Women's with persistent placenta previa underwent transabdominal and transvaginal and color Doppler ultrasound evaluation in the second and third trimester because they had a high risk of adherent placentation. The sonographic signs included in this review were the ones most commonly reported to be associated with invasive placentation: vascular lacunae within the placenta, loss of normal hypoechogenic retroplacental zone, interruption of the bladder line and/or focal exophytic masses extending into the bladder spaces and color Doppler abnormalities such as abnormal blood vessels at the myometrium. Results: Over four year, a total of 78 placenta previa persistent were identified and in 17 (21.8%) cases surgical findings confirmed invasive placentation. The morbidity of Caesarean hysterectomy