912 September 2012, Copenhagen, Denmark

P20: PATIENT SA F E T Y
P20.01
The 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 University
College 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 the
influence 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 Yonsei
University Health System between January 2005 and March 2011
were enrolled. If more than one myoma was detected, the largest
one was considered to be representative. The number, size, position,
and location of the uterine myomas and the perinatal complications
were analyzed.
Results: The women were 33.1 3.9 years of age and delivered
infants, 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 to
preterm premature rupture of membranes, incompetent cervix, and
intrauterine fetal death resulted in postpartum hemorrhage caused
by retaind placenta. Acute pain localized at myoma site requiring
analgesics occurred in 9 (13%) of the women at 1722 weeks. The
fibroids located at uterine fundus were highly associated with the
pain symptom (P < 0.05). Preterm labor showed in 12 (17.4%)
cases, 50% of which led to preterm delivery. A Cesarean section was
performed in 65% of the pregnancies with vertical uterine incision
in 11% thereof. Intraoperative bleeding amount was 726 289 ml.
The size of the fibroids remained unchanged during pregnancy in
most cases.
Conclusions: Large uterine myoma may cause abdominal pain,
preterm delivery, high rate of cesarean section, intrauterine fetal
death and postpartum hemorrhage. However, the neonatal outcome
was not adversely affected by large myoma during pregnancy.

P20.02
Antenatal 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,
Palma
de Mallorca, Spain
Objectives: Determine the predictive ability of placenta accreta in
prenatal ultrasound diagnosis in our general population of pregnant
women.
Methods: A prospective study of 8999 women during the period
Jan 08 to Aug 11. We searched for suspicious sonographic signs of
placenta accreta: numerous vascular lacunae, absent lower uterine
segment between bladder and placenta, turbulent or complicated
blood flow at the uteroplacental interface with particular attention
to cases with previous cesarean section and / or placenta previa.
Results: There were 7 cases of placenta accreta, 6 diagnosed prenatally and 1 postnatally. There were no false positives, sensitivity was
85.7%, specificity 99.9%, PPV 100% and NPV 99.9%. The average
age was 36 years, all the placenta acreta cases had at least one
previous Cesarean section and 6/7 had placenta previa. The median
gestational age at diagnosis was 20.5 weeks The pathological study
confirmed the diagnosis of placenta increta in 4 cases, percreta in
2, and parcial accreta in 1 case. All cases required a postpartum
hysterectomy. In 5 of them an elective surgery was performed by a
multidisciplinary team while the other two underwent urgent surgery
due to hemorrhagic shock. All patients required transfusion with
an average of 6 packed red blood cells (4 in elective surgery versus
11.3 in urgent surgery). Blood loss was significantly higher in urgent

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

Poster abstracts

surgery patients. All 7 women and their newborn babies were healthy
without sequelae and all perinatal outcomes were satisfactory.
Conclusions: The incidence of placenta accreta in our environment
is almost twice as high (1/1285) as the incidence described in the
literature (1/2500), probably because the incidence of Cesarean
sections has increased. Antenatal identification of placenta accreta
is possible with high sensitivity and PPV, particularly in patients
presenting placenta previa and/or previous Cesarean section. This
diagnostic strategy allows the modification of the delivery approach
to avoid blood loss and major clinical complications.

P20.03
Vaginal versus abdominal scan in detection vasa previa in a
lot of 364 patients with placenta previa and low lying placenta
D. V. Deva1,2 , D. Albu1,2 , C. Albu1,3 , G. Nicolae3 ,
C. Berceanu4
1
Fetal Medicine, ALCO-SAN, Bucharest, Romania; 2 Hospital
Panait Sarbu, Bucharest, Romania; 3 University of Medicine
and Pharmacy Carol Davila, Bucharest, Romania; 4 University
of Medicine and Pharmacy Craiova, Bucharest, Romania

Objectives: To evaluate the usefulness of vaginal scan and color

Doppler in patients with risc for vasa previa.
Methods: In a prospective longitudinal study we examined 364
patients diagnosed with low lying placenta and placenta previa,
using both abdominal and vaginal ultrasound. We first examined
with abdominal probe and later by vaginal probe, and we also use
color and power Doppler, trying to detect even there smallest vasa
previa.
Results: We found 14 cases of vasa previa, 10 by abdominal scan
and the other 4 cases were detectable only by vaginal scan. 8 cases
of vase previa were diagnosed by 2D scan, and 6 cases only by color
and power Doppler scan (too small).
Conclusions: The use of vaginal scan and color and power Doppler
greatly improve the accuracy of the diagnosis of vasa previa and can
be a useful tool in prenatal scanning of high risc patients.
Supporting information can be found in the online version of
this abstract.

P20.04
Pregnancy complicated with cervical varix and low-lying
placenta: 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 Graduate
School of Medicine, Osaka, Japan
Cervical varix is extremely rare and its risk of massive hemorrhage
during delivery is high. According to a MedLine search, only 10 case
reports have been reported to date. We present a case of cervical
varix with low-lying placenta successfully managed with obstetrical
strategy. A 40-year-old Japanese gravida 2 para 1 presented at our
hospital at 18 weeks gestation. At 22 weeks gestation, transvaginal
ultrasonography revealed low-lying placenta on the posterior wall
of the uterus. At 34 weeks gestation, a large cervical varix was
noted when we evaluated the placental location. The majority of
the cervical tissue was replaced with a dilated venous plexus. The
patient had not experienced vaginal bleeding. We decided that the
optimal mode of delivery for this patient would be a cesarean
section, due to the significant risk of massive hemorrhage with
vaginal delivery. We scheduled the cesarean section for 37 weeks
and 1 day of gestation. A healthy female infant weighing 3.345 g was
delivered without difficulty. After extraction of the fetus, inspection
of the interior of the cervix and lower segment demonstrated
dilated blood vessels protruding into the lumen, with active bleeding

249