First Trimester 3D Power Doppler for Prediction of Hysterectomy in Women at Risk for PAS

eovascularization along the bladder-serosal interface is often observed in cases of placenta accreta spectrum (PAS) requiring hysterectomy. We sought to determine the relationship between 3-dimensional power Doppler (3D PD) quantification of vascular indices along the bladder-serosal interface – a potential surrogate marker of vascularization – and the outcome of hysterectomy in women with concern for PAS in the first trimester. Women with a prior cesarean and low implantation in the first trimester underwent 3D PD as part of standardized ultrasound assessment for PAS. The ultrasound imaging device used was a GE Voluson E10. An investigator blinded to clinical information employed a standardized reading protocol to select the 3D PD study with the best visualization of the bladder-serosal interface and minimal aliasing. 3D volumes were constructed from the entire placental mass along the bladder serosal interface. Vascular indices were then extracted from this volume and compared based on the outcome of hysterectomy. The Wilcoxon Rank Sum Test was used for statistical analysis. Each 3D PD study was analyzed independently on two different days to assess intra-observer reliability. Between March 2021 to June 2022, 16 women had first trimester 3D PD studies and delivery data available for analysis. Six women required hysterectomy. The vascularization index, vascularization flow index, and flow index were significantly higher in those women requiring hysterectomy (P < 0.01, Table). The intra-observer reliability was 0.94, 0.95, and 0.95 for vascularization index, vascularization flow index, and flow index respectively. Vascular indices based on 3D PD in the first trimester are significantly higher in women requiring hysterectomy. Intra-observer reliability was excellent. Further assessment to validate these findings and assess for predictive capability will enhance clinical management of these complicated cases.View Large Image Figure ViewerDownload Hi-res image Download (PPT)