Bourgioti Charis, Konidari Marianna, Eleftheriades Makarios, Theodora Marianna, Nikolaidou Maria Evangelia, Zafeiropoulou Konstantina, Tzavara Chara, Fotopoulos Stavros, Daskalakis George, Moulopoulos Lia Angela
First Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece.
Second Department of Obstetrics and Gynaecology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 11528 Athens, Greece.
Diagnostics (Basel). 2024 Apr 29;14(9):925. doi: 10.3390/diagnostics14090925.
Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior-posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied.
胎盘植入谱系障碍（PAS）是围产期孕产妇发病和死亡的主要原因之一；孕期早期识别对确保最佳临床结局至关重要。本研究旨在探讨MRI上前置胎盘的存在、类型/位置与PAS及孕产妇围产期结局之间的可能关联。189例PAS高危孕妇（平均年龄：35岁；平均孕周：32周）接受了专门的胎盘MRI检查。所有孕妇在MRI检查后6周内均接受了剖宫产。两名经验丰富的泌尿生殖放射科医生对所有MRI图像进行评估，以确定前置胎盘的存在、类型（完全性/部分性与边缘性/低置性）和位置（前位与前后位与后位）。对前置胎盘的类型/位置与胎盘侵入性及围产期结局之间的可能关联进行了统计分析。术中信息用作参考标准。143/189例（75.6%）孕妇检测到完全性/部分性前置胎盘，33/189例（17.5%）孕妇检测到边缘性/低置性前置胎盘；88/189例（46.6%）孕妇胎盘位于前后位，54/189例（28.6%）位于前位，41/189例（21.7%）位于后位。与低置性/边缘性胎盘相比，完全性/部分性前置胎盘的侵入可能性至少高3倍，且更常与不良围产期事件相关，包括术中大量失血或子宫切除术。胎盘后位与PAS发生率较低及更好的临床结局显著相关。总之，MRI显示的前置胎盘类型和位置似乎与分娩期间并发症的严重程度相关，应仔细研究。
