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Ultrasound/Imaging

Poster Session 1

(291) Association of resolving placenta previa and other early sonographic markers with postpartum hemorrhage

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Presenting Author(s)

  • TQ

    Teresa Qi, MD (she/her/hers)

    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, NY, United States

    • Primary Author(s)

  • Alexa L. Cohen, MD

    Fellow
    Montefiore Medical Center, Albert Einstein College of Medicine
    Bronx, NY, United States

    • Coauthor(s)

  • CM

    Christine Miguel, MD

    Montefiore Medical Center, Albert Einstein College of Medicine
    Manhasset, NY, United States

  • MP

    Melissa Peskin-Stolze, MD

    New York University Grossman Long Island School of Medicine
    New York, NY, United States

  • Pe'er Dar, MD

    Professor and Director, Division of Fetal Medicine
    Montefiore Medical Center, Albert Einstein College of Medicine
    New York, NY, United States

  • Georgios Doulaveris, MD

    Assistant Professor
    Montefiore Medical Center, Albert Einstein College of Medicine
    Bronx, NY, United States

Objective: Low placentation is associated with increased risk of postpartum hemorrhage (PPH). There is a paucity of data on the association between low placentation on second trimester ultrasound that later resolves, and PPH. We hypothesized that due to lower uterine segment neovascularization seen with low placentation, it's resolution before labor does not eliminate the increased risk of PPH. Aim of this study was to investigate association of low placentation and other early prenatal ultrasound markers, and future development of PPH.

Study Design: This was retrospective matched case-control (1:1) study of full term, singleton pregnancies complicated by PPH who delivered vaginally at our regional perinatal referral center between 2018 - 2022. PPH was defined as blood loss > 1L within 24 hours of delivery. Primary exposure variable was second trimester placenta previa (defined as complete or marginal previa, or low-lying placenta within 10mm from internal os) that resolved prior to labor. Additional exposure variables included leiomyoma, first trimester subchorionic hematoma, and second trimester cervical length< 25mm, polyhydramnios or estimated fetal weight over 90%tile. Chi-square test and unpaired student t-test were used to compare categorical and continuous variables, respectively. Multivariable logistic regression was also performed.

Results:

We compared 400 gravidas with PPH to 400 without. They were matched by age, parity, gestational age at delivery and mode of delivery. PPH occurred more often in cases with resolved previa versus controls (12% vs 4.6%, p< 0.01). On multivariate analysis, those with resolved previa were 2.85 times more likely to have PPH, compared to controls, (95%CI 1.52-5.31, p< 0.01). PPH rate was also higher in those with leiomyoma (aOR 3.03, 95%CI 1.25-7.39, p=0.01). Rates of subchorionic hematoma, short cervical length, polyhydramnios and estimated fetal weight >90% were similar between groups.

Conclusion: A finding of low placentation on second trimester ultrasound is associated with increased risk of PPH, even when it appears to resolve in the third trimester.