Placenta accreta spectrum (PAS) is defined as an abnormal trophoblast invasion into the myometrium, and sometimes up to or beyond the serosa. The pathogenesis is mostly due to placental implantation at an area of defective decidualization caused by pre-existing damage to the endometrial-myometrial interface. 1,2 Depending on the degree of invasion, PAS can be classified as placenta accreta when anchoring placental villi attach to the myometrium (rather than decidua), placenta increta when anchoring placental villi penetrate into the myometrium, and placenta percreta when anchoring placental

Objective To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). Methods A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non‐SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. Results SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7–16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55–0.98); specificity was 0.76 (95% CI 0.50–0.93). Conclusion Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.

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A case of successful management of a pregnant patient with a diagnosis of uncorrected transposition of the great arteries from 32 weeks to cesarean delivery at 37 weeks.

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Introduction25% of maternal deaths worldwide are due to postpartum hemorrhage (PPH)1. Tissue hypoperfusion causes anaerobic respiration and lactic acid production. Lactate measurement has shown prognostic utility in different clinical conditions as severe sepsis and polytrauma.ObjectiveTo Determine whether the concentration of serum lactate measured at the diagnosis of postpartum hemorrhage indicates the development of severe hemorrhage.Material and MethodologyA prognostic cohort study was carried out including 30 patients in vaginal labor and cesarean section who presented bleeding ≥ 500 ml measured by gravimetric method. A venous blood sample was taken for analysis of serum lactate. Those with a total loss of ≥ 1500 ml at the end of labor were classified with severe bleeding. The relationship between serum lactate elevation and development of severe hemorrhage (SPPH) was analyzed by chi‐square and odds ratio was calculated. The best cut point was determined by Curve‐ROC, and its prognostic capacity was compared with the cut‐off point of 2.2 mmol/l as used in ATLS.ResultsThirty patients were analyzed. General average volume of bleeding: 1260 + 691 ml; in severe group was 1700 + 690 ml and 1100 + 224 ml in non‐severe, p = 0.0004. General average serum lactate: 2.68 + 1.8 mmol/l; in severe group 3.24 + 3 mmol/l vs non‐severe 2.28 + 0.54 mmol/l, p = 0.0120. The cut point that best differentiates the groups was 2.6 mmol/l, OR of 12.50 (1.34–116.8), p = 0.017; sensitivity: 0.71 (0.29–0.96); specificity 0.83 (0.52–0.98) and AUC = 0.74 for severe hemorrhage.ATLS cut point of 2.2 mmol/l had RR of 3.65 (0.57,23.37), OR 6.55 (0.68, 63.33, 0.077 sensibility of 0.92 (0.64, 1.00), specificity of 0.35 (0.14, 0.62) positive predictive value of. 1.43 (0.97, 2.10)Support or Funding InformationConsejo Nacional de Ciencia y Tecnología (CONACYT) COMPARATIVE TABLE Cut points RR OR P VALOR Sensibilidad Especificidad PPV 2.2 3.65 (0.57, 23.37) 6.55 (0.68, 63.33) 0.077 0.92 (0.64, 1.00) 0.35 (0.14, 0.62) 1.43 (0.97, 2.10) 2.6 5.50 (1.46, 20.71) 17.88 (2.73, 116.88) <0.001*** 0.85 (0.55, 0.98) 0.76 (0.50, 0.93) 3.60 (1.48, 8.74) RR: RELATIVE RISK OR: ODDS RATIO PPV: POSITIVE PROGNOSTIC VALUE This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.