Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
Department of Obstetrics and Gynecology, The Affiliated SuQian first people's Hospital of Nanjing Medical University, SuQian, Jiangsu, China.
J Magn Reson Imaging. 2023 Oct;58(4):1047-1054. doi: 10.1002/jmri.28617. Epub 2023 Feb 27.
Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa.
To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal-fetal outcomes in women with complete placenta previa.
Retrospective.
A total of 141 pregnant women (median age, 32; age range, 24-40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition.
FIELD STRENGTH/SEQUENCE: A 3 T with T -weighted imaging (T WI), T -weighted imaging (T WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence.
The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal-fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups.
The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference.
The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941.
Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal-fetal perinatal outcomes in patients with complete placenta previa.
完全性前置胎盘与更高比例的不良临床结局相关，磁共振成像（MRI）广泛应用于前置胎盘患者的术前检查。
评估下段子宫胎盘面积和宫颈长度在识别完全性前置胎盘患者不良母婴结局中的作用。
回顾性。
共 141 例经 MRI 检查的完全性前置胎盘孕妇（中位年龄 32 岁，年龄范围 24-40 岁），评估胎盘子宫状况。
磁场强度/序列：3.0T 采用 T1 加权成像（T1WI）、T2 加权成像（T2WI）和半傅里叶采集单次激发快速自旋回波（HASTE）序列。
采用 MRI 测量下段子宫胎盘面积和宫颈长度与术中大量出血（MIH）和母婴围生期结局的风险的相关性。分析不同组别的不良新生儿结局（早产、呼吸窘迫综合征[RDS]、新生儿重症监护病房[NICU]收治）。
采用 t 检验、Mann-Whitney U 检验、卡方检验、Fisher 确切检验和受试者工作特征（ROC）曲线，P<0.05 表示具有统计学意义。
胎盘面积较大且宫颈较短的患者手术时间、术中出血量和术中输血均显著高于胎盘面积较小且宫颈较长的患者。胎盘面积较大组和宫颈较短组的不良新生儿结局发生率显著高于胎盘面积较小组和宫颈较长组，如早产、RDS 和 NICU。将胎盘面积与宫颈长度相结合，其对 MIH>2000ml 的诊断敏感性和特异性分别提高至 93%和 92%，ROC 曲线下面积（AUC）为 0.941。
完全性前置胎盘患者胎盘面积大、宫颈短可能与 MIH 风险增加及母婴围生期不良结局相关。
2 级。
