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Q&A

Clinical Obstetrics

Poster Session 2

(573) Does the addition of MRI in antenatal management of suspected PAS impact maternal surgical outcome?

Tuesday, February 13, 2024
3:30 PM – 5:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Antenatal diagnosis of placenta accreta spectrum (PAS) is difficult and sometimes uncertain. In the United States, up to 50% of patients with PAS are never diagnosed until the time of delivery. Diagnosis of PAS at the time of delivery can result in poor maternal outcomes. The objective of this study was to assess if the addition of an MRI in antenatally suspected PAS resulted in improved surgical outcomes.

Study Design: Multicenter retrospective cohort study of histopathologically confirmed PAS cases 1/1/2013 - 6/30/2022 at four New York academic institutions. All patients with antenatal suspicion of PAS were included and subdivided into those with and without MRI. Primary outcome was composite maternal surgical morbidity (CMSM) (transfusion of >4u PRBC, >1 vasopressors, mechanical ventilation, ICU admission and injury to surrounding organs). Outcomes were analyzed using univariate and multivariate logistic regression adjusting for confounders.

Results: 291 patients were included, 134 (46.0%) and 157 (54.0%) with and without MRI, respectively. MRI usage was associated with low placentation (60% vs. 40%, p< 0.001) and those with an interdisciplinary meeting (83% vs. 17%, p< 0.001). 184 (63%) patients had grade 1 PAS, 59 (20%) had grade 2 and 48 (16%) had grade 3. There was a significant difference in CMSM in patients who underwent an antenatal MRI evaluation (OR 11.5, 4.0-48.92, p< 0.001); however, after multivariate analysis, there was no significant difference in CMSM with the addition of MRI even when controlling for grade of PAS (aOR 2.80, 0.54-18.35, p=0.24) (Table 1).

Conclusion: There was no significant difference in composite maternal surgical morbidity outcomes for patients with sonographically suspected PAS with the addition of MRI. Our data supports prior studies that reflect antenatal MRI does not appear to impact surgical outcomes which is true even when controlling for degree of invasion with PAS. Further prospective studies are needed to support the best use of MRI as an adjunct to ultrasound for antenatal diagnosis.