AbstractObjectiveTo select a group at high risk of placenta accreta spectrum disorders (PAS) based on the data of serum screening in the first trimester.MethodsA retrospective analysis of 48 patients with abnormal placental location (AP), including placenta previa (PP) only (n = 23) and PP and PAS (n = 25), was performed. Additionally, the AP group was divided depending on the blood loss volume: not higher than 1000 mL (LBL) (n = 29) and higher than 1000 mL (HBL) (n = 19); diagnostic term of PAS by ultrasound, data pregnancy-associated plasma protein-A (РAРР-A) and free β subunit of human chorionic gonadotropin (free β-hCG) multiple of median (MоM) at 11+0–13+6 weeks of gestation were evaluated. Serological markers were compared with the data of 39 healthy pregnant women with scar after previous cesarean section and normal placental location (control).ResultsThe mean gestation at diagnostic term of PAS was 29 weeks. PAPP-Р MоM [mean (M) ± standard deviation (SD)] was: in controls, 1.07 ± 0.47; in the AP group, 1.59 ± 0.24; in PP, 1.91 ± 1.52; in PAS, 1.30 ± 0.85; in LBL, 1.37 ± 1.20; in HBL, 1.91 ± 1.24. The difference between control/AP, control/PP, control/PAS, PP/PAS, control/LBL, control/HBL and LBL/HBL was Р = 0.256, 0.145, 0.640, 0.311, 0.954, 0.025 and 0.09, respectively. Free β-hCG MoM (M ± SD) was: in controls, 1.08 ± 0.69, in AP, 1.31 ± 0.96; in PP, 1.46 ± 0.19; in PAS, 1.16 ± 0.65; in LBL, 1.30 ± 0.06; in HBL, 1.32 ± 0.78. Comparison of free β-hCG AP with controls and between subgroups did not reveal a significant difference.ConclusionUnderestimation of PAS risk factors in pregnant women with AP leads to late diagnostics of pathology only in the third trimester. The assessment of the РAРР-A level in the first trimester may be helpful for the early prognosis of pathological blood loss at delivery for pregnant women with AP and for forming the high-risk group for PAS.

Poster abstracts deep endometriosis were submitted to US and MR so as to correlate the findings. In both methods the sizes, location and the extension of the lesions were analyzed. Results: US detected a total of 40 lesions meanwhile MR detected 53 lesions in the pelvis. The comparative study between US and MR has not shown significant statistical difference (P > 0, 19% and P > 0, 14%, respectively). Taking into consideration rectosigmoid junction, MR has detected one lesion (5.6%) meanwhile US has indicated four lesions (22.2%). In the rectum lesions, US has detected eight (44.4%) and MR detected seven lesions (38.9%). Conclusions: US presented better results in the rectosigmoid junction and in the rectum; however it has detected a smaller number of lesions in the pelvis. In the global comparative analyses between US and MR in the detection of the lesions, there was no significant statistical difference.Supporting information can be found in the online version of this abstract. Objectives: To research the peculiarities of uterus tissual blood flow during steroid therapy of adenomyosis. Methods: 66 patients with adenomyosis, diagnosed according to clinical symptoms, transvaginal ultrasonography with color Doppler imaging (CDI) and loop biopsy of myometrium, were treated with combination of 30 mkg of ethinylestradiol and 2 mg of dienogest for 3 months daily and then for 9 months under contraception regimen, the menstrual blood volume, dysmenorrhea, the quantity of blood flow loci in myometrium were meanwhile observed. The patients were divided in two groups according to treatment results: effective -60, ineffective -6. Results: In the first 6 months of treatment, the menstrual blood volume was reduced significantly (P < 0.01) in both groups, and dysmenorrhea was obviously relieved. According to the data of CDI the quantity of color loci in middle and internal layers of myometrium per unit area during the treatment in the first group was reduced by the 3 month (P < 0.01) and didn't change during the treatment and for 3 months after cessation of therapy. In the second group recurrences of haemorrhage and/or dysmenorrhea served as indications for surgical treatment in 2 cases 8-10 months since the beginning of treatment, in 4 cases in 3 months after the cessation. In this group the reduction of myometrium vascularisation level wasn't registered in 5 cases in the whole course of observation. The difference in quantity of blood flow loci in 3 and 6 months after the beginning of the treatment between groups was significant (P < 0.05). Conclusions: Continuously high level of myometrium vascularisation according CDI data can serve as a predictor of ineffectiveness of steroid therapy of patients with adenomyosis.

Objective: To validate the use of placenta accreta risk-antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS).Methods: This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001).Results: Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06). Conclusion:PAR-A score is a novel scoring system of PAS outcomes, which showed external validity based on current data.

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