Category: Operative Obstetrics
Poster Session II
The use of magnetic resonance imaging (MRI) remains controversial in the diagnosis of placenta accreta spectrum (PAS). The purpose of this study was to examine if the use of MRI influenced surgical outcomes in patients with PAS.
Study Design:
This is a single institution, retrospective study at a tertiary care center from 2009 to 2019. Subjects with pathology proven PAS on hysterectomy specimens were identified from a collected dedicated database and surgical outcomes were compared in subjects that had MRI as part of pre-surgical evaluation versus subjects who had ultrasound alone.
Results:
Forty-four patients had cesarean hysterectomy with pathology proven PAS; 23 had MRI performed as part of the pre-surgical evaluation and 21 had ultrasound alone. Baseline demographics are listed in Table 1 and no significant differences were noted. Women in the MRI implementation group were more likely to have findings of suspected bladder involvement seen on ultrasound imaging (p=0.02). Regarding surgical outcomes (Table 2), with the exception of ICU admission, there was no observed differences between the groups with regard to surgical outcomes. There were no observed differences in the pathology between the groups (p=0.568; Table 1). However, in a sub-analysis of subjects with suspected sonographic bladder involvement, subjects in the MRI group were observed to have less estimated blood loss (put mean with +/- in parentheses with p-value) and a significant decrease in need for greater than 10 units of blood product transfusion (p=0.019) and decrease in need for post-operative ICU admission (p=0.033).
Conclusion:
The use of MRI in subjects with PAS did not demonstrate improved surgical outcomes in comparison to ultrasound alone. In cases of sonographically suspected bladder involvement, the use of MRI was observed to have less overall blood loss and decreased transfusion >10 units, suggesting a possible avenue of inquiry. Further study, on a larger population of patients is warranted to further evaluate the role of MRI in PAS.
Ernesto Licon, MD
Maternal-Fetal Medicine Fellow
University of California at Irvine
Pasadena, California, United States
Oluwatoni Okuyemi, MD
University of California at Irvine
Orange, California, United States
Alice Sherman-Brown, MD
University of California, Irvine
Orange, California, United States
Adam Crosland, MD,MPH
Maternal Fetal Medicine Physician
Oregon Health and Science University Hospital
Long Beach, California, United States
Michael P. Nageotte, MD
Miller Children's and Women's Hospital
Long Beach, California, United States
Vineet Shrivastava, MD
Long Beach Memorial Medical Center Women's Hospital and UC Irvine
Long Beach, California, United States