Endometrial Calcifications: A Novel Sonographic Marker of Endometrial Injury
ACOG ePoster. Starostanko A. Apr 27, 2018; 212026; 29N
Dr. Andrea Starostanko
Dr. Andrea Starostanko
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Introduction: Morbidly adherent placenta (MAP) has increased 10-fold in the last fifteen years and is associated with injury to the decidua basalis especially with placental implantation over a previous surgical scar. Transvaginal ultrasound (TVUS) can detect endometrial calcifications (EMC), which pathologically, indicate localized basalis injury. The purpose of this investigation is to determine if ultrasound evidence of EMC is seen more commonly in women with a history of cesarean delivery.

Methods: TVUS performed in non-pregnant women were reviewed for the presence of EMC. Women were stratified into 4 groups: 1) nulliparous; 2) one prior vaginal delivery; 3) one prior cesarean delivery (CD) with surgical incision above the internal os; and 4) one prior CD with surgical incision below the internal os.

Results: TVUS from 518 women were evaluated. EMC were noted in 4% of nulliparous women and 60% of women with one prior vaginal delivery. Sixty percent of patients with a prior CD had evidence of EMC within the surgical scar. Eighty-seven percent of women with a prior CD with a surgical incision below the internal os had localized EMC within the surgical scar.

Conclusion/Implications: Parous women are more likely than nulliparous women to have EMC, likely from the placental implantation site. We propose that the combination of localized calcifications within a prior surgical scar, particularly when the incision is below the internal os (area of relatively decreased vascularity), synergistically predisposes patients to increased basalis injury and potentially MAP. This novel marker could be used to predict the risk of MAP in future pregnancies.
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