EP16.24: Preoperative identification and stratification of placenta percreta for team management: can we improve?

Placenta Accreta Spectrum (PAS) has significant maternal morbidity. Multidisciplinary team involvement in the care patients with placenta percreta (PP), the highest risk pathology, has shown improved patient outcomes. Our aim for this study was to identify preoperative characteristics of patients with placenta percreta in order to allow for optimal team management by preoperative stratification. A retrospective single institution case-control study was performed from 2011-2022 of pregnancies with suspicion for PAS. Ultrasonography was used as the primary method of detection. Final inclusion was dependent on histology confirmation of PAS. We also explored the role of concurrent MRI antenatal imaging on patients with previously unrecognised placenta percreta. 140 cases of histologically confirmed PAS were managed by our team. 72 (51.4%) of cases were for placenta percreta and 27 (37.5%) of these were diagnosed preoperatively while 45 (62.5%) were only diagnosed postoperatively. BMI >30 and was independently associated with unrecognised placenta percreta (p = 0.006). No findings by MRI were associated with mischaracterization of placenta percreta. Yet, concurrent MRI assessment of patients with BMI >30 (n = 18), increased placenta percreta detection by 61%. The ability to determine preoperatively which patients are more likely to have placenta percreta allows optimal care. This study shows that women at risk for PAS with non-percreta US who are obese (BMI >30) may benefit from further assessment with MRI to facilitate appropriate staffing and team availability for cases of placenta percreta. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.