410 Peer audit of racial representation in contemporary obstetric guidelines

Abstract

Placenta Accreta Spectrum (PAS) represents 1:250 cases in the United States. PAS is associated with significant maternal morbidity and mortality. Numerous centers for the care of PAS patients have been established and data suggested optimal outcomes with referral to a PAS center. Current referral guidelines rely on historic and ultrasonographical findings although less than 50% of cases are successfully referred to centers using these criteria. Thus, our goal was to explore the utility of Placental Growth Factor (PlGF) as a biomarker for high risk patients with Placenta previa and PAS. STUDY DESIGN: Urine specimens were collected from patients with suspected PAS, placenta previa, and scheduled repeat cesarean sections. Quantitative analysis of PlGF was performed by ELISA. Expression profiles were correlated and analyzed for diagnostic accuracy and reproducibility. RESULTS: Specimens were collected from a total of 24 subjects (12 PAS, 6 previa, 6 control). PlGF urine quantities were assessed by ELISA. Average urine PlGF quantities were 6.1, 18.2, and 17.6 pg/mL for control, previa and PAS subjects respectively (p¼0.24). In addition the PAS cohort was subdivided by traditional pathology (accreta, increta, percreta), there was no statistically significant difference in final pathology (p¼0.67). CONCLUSION: Placental growth factor expression may be detected in the urine of patients with placenta previa and PAS. PlGF quantities may distinguish between control subjects but cannot distinguish between placenta previa and PAS. PlGF did not discriminate among the PAS pathologies (accreta, increta, percreta). PlGF may serve as part of a developing biologic hierarchy for the detection and referral of high risk patients to tertiary centers of care.