Chen Daijuan, Xu Jinfeng, Ye Pengfei, Li Mier, Duan Xia, Zhao Fumin, Liu Xinghui, Wang Xiaodong, Peng Bing
Department of Obstetrics and Gynecology, West China Second University Hospital of Sichuan University and the Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Sichuan, China.
West China School of Medicine, Sichuan University, Sichuan, China.
J Magn Reson Imaging. 2020 Mar;51(3):947-958. doi: 10.1002/jmri.26922. Epub 2019 Sep 11.
Placenta previa and accreta are serious obstetric conditions that are associated with a high risk of intraoperative massive hemorrhage.
To develop a scoring system for intraoperative massive hemorrhage combining MRI and clinical characteristics to predict the risk of massive hemorrhage in placenta previa and accreta STUDY TYPE: Retrospective cohort study.
In all, 374 patients consisting of 259 patients with placenta previa and accreta after previous cesarean section (CS) for the derivation cohort and 115 patients for the validation cohort.
FIELD STRENGTH/SEQUENCE: 1.5T single-shot fast spin-echo sequence. [Correction added on October 23, 2019, after first online publication: The field strength in the preceding sentence was corrected.] ASSESSMENT: Using the derivation cohort, clinical and MRI data were collected and multivariable logistic regressions analysis was conducted to develop a scoring system for prediction of intraoperative massive bleeding (blood loss volume > 2000 mL). Finally, the scoring system was validated on 115 patients.
Student's t-test, Mann-Whitney U-test, X statistics, multivariable analysis, and receiver operating characteristic (ROC) analysis.
Ten indicators, including clinically maternal age (1 point), preoperative hemoglobin level (1 point), gravidity number (1 point), number of CS (1 point), and MRI T dark intraplacental bands (4 points), cervical canal length (3 points), placenta thickness on the uterine scar area (4 points), empty vascular shadow of the uterus (1 point), low signal discontinuity in the muscular layer of the posterior wall of the bladder (6 points) and attachment position of the placenta (1 point) were imputed. From the ROC analysis, a total score of 7 points was identified as the optimal cutoff value, allowing good differentiation of intraoperative massive bleeding in the derivation cohort (AUC, 0.863; 95% confidence interval [CI]: 0.811-0.916) and in the validation cohort (AUC, 0.933; 95% CI: 0.885-0.980).
The scoring system for intraoperative massive hemorrhage consists of MRI and clinical indicators, and using a cutoff value of 7 points for a high risk of massive bleeding, the developed scoring system could accurately assess the risk of intraoperative massive hemorrhage in patients with placenta previa and accreta. This scoring system can potentially reduce the incidence of intraoperative massive bleeding by identifying patients at high risk.
3 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:947-958.
前置胎盘和胎盘植入是严重的产科情况，与术中大量出血的高风险相关。
开发一种结合MRI和临床特征的术中大量出血评分系统，以预测前置胎盘和胎盘植入患者术中大出血的风险。研究类型：回顾性队列研究。
总共374例患者，其中259例为既往剖宫产术后发生前置胎盘和胎盘植入的患者作为推导队列，115例患者作为验证队列。
场强/序列：1.5T单次激发快速自旋回波序列。[2019年10月23日首次在线发表后添加的更正：上一句中的场强已更正。]评估：使用推导队列，收集临床和MRI数据，并进行多变量逻辑回归分析，以开发预测术中大量出血（失血量>2000 mL）的评分系统。最后，在115例患者中对该评分系统进行验证。
学生t检验、曼-惠特尼U检验、X²统计、多变量分析和受试者操作特征（ROC）分析。
纳入了10项指标，包括临床产妇年龄（1分）、术前血红蛋白水平（1分）、妊娠次数（1分）、剖宫产次数（1分）、MRI胎盘内T2加权暗带（4分）、宫颈管长度（3分）、子宫瘢痕区域胎盘厚度（4分）、子宫血管空影（1分）、膀胱后壁肌层低信号中断（6分）和胎盘附着位置（1分）。通过ROC分析，确定总分为7分是最佳截断值，在推导队列（AUC，0.863；95%置信区间[CI]：0.811 - 0.916）和验证队列（AUC，0.933；95%CI：0.885 - 0.980）中能够很好地区分术中大量出血情况。
术中大量出血评分系统由MRI和临床指标组成，使用7分作为大出血高风险的截断值，所开发的评分系统能够准确评估前置胎盘和胎盘植入患者术中大出血的风险。该评分系统有可能通过识别高风险患者来降低术中大量出血的发生率。
3。技术效能：5级。《磁共振成像杂志》2020年；51：947 - 958。
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