Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, 215002, Jiangsu, China.
Department of Medical Imaging, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
BMC Pregnancy Childbirth. 2024 Jan 10;24(1):52. doi: 10.1186/s12884-024-06247-y.
Placenta accreta spectrum (PAS) carries an increased risk of maternal-fetal mortality and morbidity, and magnetic resonance imaging (MRI) features for PAS have been used for preoperative identification. This study aims to investigate the role of placental volume evaluated by MRI in identifying PAS in pregnant women with complete placenta previa.
Totally 163 cases of complete placenta previa pregnant women with a history of cesarean section underwent MRI for suspected PAS were included. We categorized the patients into two groups according to the presence or absence of PAS, and the maternal-fetal perinatal outcomes and placental volume analyzed by 3D Slice software were compared.
There were significantly more gravidity, parity, and number of previous cesarean delivery in the PAS group (P < 0.05). Significant differences were also found between the two groups with respect to the following baseline characteristics: gestational age at delivery, intraoperative blood loss, blood transfusion, and neonatal birth weight (P < 0.05). Of 163 women in the study, 7 (4.294%) required cesarean hysterectomy for high-grade PAS or pernicious bleeding during cesarean section, and PAS was confirmed with histologic confirmation in 6 (85.714%) cases. The placental volume in PAS group was greater than that in the non-PAS group (P < 0.05). With a threshold of more than 887 cm, the sensitivity and specificity in identifying PAS were 85.531% and 83.907% respectively, with AUC 0.908 (95% CI: 0.853-0.948).
Placental volume may be a promising indicator of PAS in complete placenta previa patients with a history of cesarean section.
胎盘植入谱系疾病（PAS）会增加母婴死亡率和发病率，磁共振成像（MRI）特征已用于术前识别。本研究旨在探讨 MRI 评估胎盘体积在识别有剖宫产史的完全性前置胎盘孕妇 PAS 中的作用。
共纳入 163 例有剖宫产史的完全性前置胎盘孕妇，怀疑 PAS 行 MRI 检查。根据 PAS 的有无将患者分为两组，比较两组产妇-胎儿围生期结局和 3D Slice 软件分析的胎盘体积。
PAS 组的孕次、产次和剖宫产次数明显更多（P<0.05）。两组在以下基线特征方面也存在显著差异：分娩时的孕龄、术中出血量、输血和新生儿出生体重（P<0.05）。在研究的 163 名妇女中，7 名（4.294%）因高级别 PAS 或剖宫产术中恶性出血需要行剖宫产子宫切除术，6 名（85.714%）病例经组织学证实 PAS。PAS 组的胎盘体积大于非 PAS 组（P<0.05）。阈值超过 887 cm 时，识别 PAS 的灵敏度和特异度分别为 85.531%和 83.907%，AUC 为 0.908（95%CI：0.853-0.948）。
胎盘体积可能是有剖宫产史的完全性前置胎盘孕妇 PAS 的一个有前途的指标。
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