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912 September 2012, Copenhagen, Denmark Poster abstracts

P 2 0 : P A T I E N T S A F E T Y

P20.01The influence of large uterine myoma on pregnancy outcome

Y. Lee, J. Park, S. Jung, J. Kwon, Y. Kim, Y. Park, G. Son

Department of Obstetrics and Gynecology, Yonsei UniversityCollege of Medicine, Seoul, Republic of Korea

Objectives:Uterine myomas are benign disease observed in 2 to 3%of all normal pregnancies. The aim of this study is to assess theinfluence of large uterine myomas on obstetric outcome.Methods: Sixty nine pregnant women with large uterine myoma(8 cm or greater) identified by second trimester ultrasound scans(Accuvix XQ, Medison Co., Seoul, Korea) who delivered at YonseiUniversity Health System between January 2005 and March 2011were enrolled. If more than one myoma was detected, the largestone was considered to be representative. The number, size, position,and location of the uterine myomas and the perinatal complicationswere analyzed.Results: The women were 33.1 3.9 years of age and deliveredinfants, weighing 3098 600 g at 36.6 5.6 weeks of gestation.Intrauterine fetal deaths at second trimester were noted in two cases.

Three pregnancies terminated between 16 and 20 weeks due topreterm premature rupture of membranes, incompetent cervix, andintrauterine fetal death resulted in postpartum hemorrhage causedby retaind placenta. Acute pain localized at myoma site requiringanalgesics occurred in 9 (13%) of the women at 1722 weeks. Thefibroids located at uterine fundus were highly associated with thepain symptom (P < 0.05). Preterm labor showed in 12 (17.4%)cases, 50% of which led to preterm delivery. A Cesarean section wasperformed in 65% of the pregnancies with vertical uterine incisionin 11% thereof. Intraoperative bleeding amount was 726 289 ml.The size of the fibroids remained unchanged during pregnancy inmost cases.Conclusions: Large uterine myoma may cause abdominal pain,preterm delivery, high rate of cesarean section, intrauterine fetaldeath and postpartum hemorrhage. However, the neonatal outcome

was not adversely affected by large myoma during pregnancy.

P20.02Antenatal screening of placenta accreta

A. Tubau, M. Juan, B. Soriano, A. Ruiz, L. Moles, J. Grau,M. Ferragut

Maternal Fetal Medicine Unit, Hospital Son LLatzer, Palmade Mallorca, Spain

Objectives:Determine the predictive ability of placenta accreta inprenatal ultrasound diagnosis in our general population of pregnantwomen.Methods: A prospective study of 8999 women during the period

Jan 08 to Aug 11. We searched for suspicious sonographic signs ofplacenta accreta: numerous vascular lacunae, absent lower uterinesegment between bladder and placenta, turbulent or complicatedblood flow at the uteroplacental interface with particular attentionto cases with previous cesarean section and / or placenta previa.Results:There were 7 cases of placenta accreta, 6 diagnosed prena-tally and 1 postnatally. There were no false positives, sensitivity was85.7%, specificity 99.9%, PPV 100% and NPV 99.9%. The averageage was 36 years, all the placenta acreta cases had at least oneprevious Cesarean section and 6/7 had placenta previa. The mediangestational age at diagnosis was 20.5 weeks The pathological studyconfirmed the diagnosis of placenta increta in 4 cases, percreta in2, and parcial accreta in 1 case. All cases required a postpartumhysterectomy. In 5 of them an elective surgery was performed by amultidisciplinary team while theother two underwenturgentsurgery

due to hemorrhagic shock. All patients required transfusion withan average of 6 packed red blood cells (4 in elective surgery versus11.3 in urgent surgery). Blood loss was significantly higher in urgent

surgery patients. All 7 women andtheir newborn babies were healthywithout sequelae and all perinatal outcomes were satisfactory.Conclusions:The incidence of placenta accreta in our environmentis almost twice as high (1/1285) as the incidence described in theliterature (1/2500), probably because the incidence of Cesareansections has increased. Antenatal identification of placenta accretais possible with high sensitivity and PPV, particularly in patientspresenting placenta previa and/or previous Cesarean section. Thisdiagnostic strategy allows the modification of the delivery approachto avoid blood loss and major clinical complications.

P20.03Vaginal versus abdominal scan in detection vasa previa in alot of 364 patients with placenta previa and low lying placenta

D. V. Deva1,2, D. Albu1,2, C. Albu1,3, G. Nicolae3,C. Berceanu4

1Fetal Medicine, ALCO-SAN, Bucharest, Romania; 2 HospitalPanait Sarbu, Bucharest, Romania; 3 University of Medicineand Pharmacy Carol Davila, Bucharest, Romania; 4 Universityof Medicine and Pharmacy Craiova, Bucharest, Romania

Objectives: To evaluate the usefulness of vaginal scan and colorDoppler in patients with risc for vasa previa.Methods: In a prospective longitudinal study we examined 364patients diagnosed with low lying placenta and placenta previa,using both abdominal and vaginal ultrasound. We first examinedwith abdominal probe and later by vaginal probe, and we also usecolor and power Doppler, trying to detect even there smallest vasaprevia.Results: We found 14 cases of vasa previa, 10 by abdominal scanand the other 4 cases were detectable only by vaginal scan. 8 casesof vase previa were diagnosed by 2D scan, and 6 cases only by colorand power Doppler scan (too small).Conclusions:The use of vaginal scan and color and power Dopplergreatly improve the accuracy of the diagnosis of vasa previa and canbe a useful tool in prenatal scanning of high risc patients.

Supporting information can be found in the online version ofthis abstract.

P20.04Pregnancy complicated with cervical varix and low-lyingplacenta: a case report

Y. Kurihara, M. Tanaka, N. Wada, M. Kitamura,H. Nobeyama, D. Tachibana, M. Koyama, T. Sumi, O. Ishiko

Obstetrics and Gynecology, Osaka City University GraduateSchool of Medicine, Osaka, Japan

Cervical varix is extremely rare and its risk of massive hemorrhageduring delivery is high. According to a MedLine search, only 10 casereports have been reported to date. We present a case of cervicalvarix with low-lying placenta successfully managed with obstetricalstrategy. A 40-year-old Japanese gravida 2 para 1 presented at ourhospital at 18 weeks gestation. At 22 weeks gestation, transvaginalultrasonography revealed low-lying placenta on the posterior wallof the uterus. At 34 weeks gestation, a large cervical varix wasnoted when we evaluated the placental location. The majority ofthe cervical tissue was replaced with a dilated venous plexus. Thepatient had not experienced vaginal bleeding. We decided that theoptimal mode of delivery for this patient would be a cesareansection, due to the significant risk of massive hemorrhage withvaginal delivery. We scheduled the cesarean section for 37 weeksand1 day of gestation. A healthy female infantweighing 3.345 g was

delivered without difficulty. After extraction of the fetus, inspectionof the interior of the cervix and lower segment demonstrateddilated blood vessels protruding into the lumen, with active bleeding

Ultrasound in Obstetrics & Gynecology 2012; 40 (Suppl. 1):171310 249