OC017: Prostaglandin‐induced cervical ripening monitored by ultrasound

Abstract

Objective: To evaluate the efficacy of intraplacental lacunae by transvaginal sonography in diagnosing the placenta accreta and increta and the prediction of clinical outcome. Methods: Forty-seven patients delivered in our hospital with history of cesarean section, diagnosis of placenta previa totalis by transvaginal sonography, and postpartum placental pathology were included in the study. Intraplacental lacunae were classified into 4 different grades from 0 to 3 by the degree (HJ Finberg, 1992). Placental pathology was done to all the patients delivered, and in case of hysterectomy, pathologic examination of removed uterus was also performed.Then they were compared with antepartum sonographic findings. Results: The lacunae was found in 8 cases with grade 1, 11 cases with grade 2, 5 cases with grade 3, and they were not showed in 23 cases. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta accreta above grade 1 lacunae were 79.2%, 87.0%, 86.4%, and 80%, respectively. When the pathologic diagnosis of placenta and removed uterus were placenta increta or percreta, all sonographic findings were above grade 2 lacunae. Sensitivity, specificity, positive predictive value, and negative predictive value of diagnosing placenta increta with lacunae above grade 2 were 93.8%, 100%, 100%, and 96.9%. Hysterectomy was performed to 17 cases, among them, 1 case showed grade 1 lacuna, 11 cases showed grade 2 lacunae, and 5 cases showed grade 3 lacunae. Without lacunae, no hysterectomy was done. Comparing the absence of lacunae or grade 1 lacunae, the relative risks of cesarean hysterectomy was 17 folds in the above grade 2 lacunae. Conclusions: Lacunar findings of transvaginal ultrasonography in patients with placenta previa totalis and history of cesarean section are very usefulness for diagnosis of placenta accreta and increta. These might be used as a valuable clinical prognostic marker. OC015Head engagement can be determined by translabial ultrasound and is predictive of normal vaginal delivery H. P. Dietz, V. Lanzarone Royal Prince Alfred Hospital, Sydney, AustraliaObjective: Engagement of the fetal head at term has long been used as a predictor of labour outcome. Surprisingly, no attempts seem to have been made to define engagement with modern imaging techniques. A recent pilot study suggested that head engagement can be determined by translabial ultrasound and is strongly associated with delivery mode. In this paper the authors tested parameters of head engagement for their predictive value. Methods: 202 nulliparous women in their first ongoing pregnancy were seen between 36 and 40 weeks' gestation in a prospective observational study. The assessment included an interview, abdominal palpation and (in a subset of 154 women) vaginal examination for a Bishop Score, as well as translabial ultrasound. Antenatal and delivery information was obtained from patient notes and the institutional obstetric database. Head engagement was determined in the midsagittal translabial plan...