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Q&A

Clinical Obstetrics

Poster Session 2

(490) Changes in postpartum uterine artery Doppler velocimetry in subjects undergoing conservative management of placenta accreta

Tuesday, February 13, 2024

3:30 PM – 5:00 PM

Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

Primary & Presenting Author(s)

Elias Kassir, MD (he/him/his)

Maternal-Fetal Medicine Fellow
McGovern Medical School at UTHealth Houston
Houston, TX, United States

Coauthor(s)

Jennie Coselli, MD

MFM Fellow
Department of Obstetrics, Gynecology and Reproductive Sciences McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)
Houston, TX, United States
Ramesha Papanna, MD, MPH

Professor
McGovern Medical School at UTHealth Houston
Houston, TX, United States
Baha M. Sibai, MD

Professor
Hermann Memorial Hospital
Houston, TX, United States
Edgar Hernandez Andrade, MD, PhD (he/him/his)

Professor
McGovern Medical School at UTHealth Houston
Houston, TX, United States

Objective: In patients undergoing an uncomplicated birth, blood flow to the uterus decreases in the ensuing weeks with an increase in resistance to flow in the uterine arteries (UtA). In patients who undergo conservative management of placenta accreta spectrum (PAS), the placenta remains in situ, providing a plausible physiologic basis for alterations in the expected blood flow pattern to the uterus postpartum. In this study, we describe UtA Doppler findings in individuals who underwent conservative management of PAS.

Study Design:

We studied a prospective cohort of subjects with PAS. Subjects who choose conservative management undergo serial postpartum ultrasound evaluations. UtA Doppler recordings were reviewed and peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI) registered, and mean values calculated. Postpartum outcomes and operative reports were reviewed. UtA Doppler measurements were plotted and linear regression analyses were performed to quantify changes over time.

Results:

18 subjects were identified; 7/18 had 3 or more postpartum Doppler evaluations. The remaining 11 subjects had fewer than 3 postpartum ultrasounds with UtA Doppler values. When the 7 subjects with 3 or more evaluations were analyzed, 5/7 (71.4%) had an increase in mean UtA PI over time, 4/7 (57.1%) had a decrease in UtA PSV, while 5/7 (71.4%) had a decrease in UtA EDV over time. Of these seven subjects, two (28.6%) were readmitted for heavy bleeding, one (14.3%) developed a coagulopathy, two (28.6%) underwent dilation and curettage, and four (57.1%) underwent interval hysterectomy.

When data were pooled for all 18 subjects, there was a statistically significant decrease in UtA EDV (p = 0.005) and increase in PI (p = 0.0004), with a non-significant trend towards decrease in PSV.

Conclusion:

In subjects undergoing conservative management of PAS with the placenta remaining in situ after delivery, blood flow to the uterus decreases over time with a concomitant increase in resistance to flow in the UtA. When aberrations in this trend are observed, patients may be at higher risk for complications.