University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Mithat Özsan Bulvarı Kışla Mah, 4522 Sok. No:1, Adana, Turkey.
University of Health Sciences Adana City Training and Research Hospital, Department of Obstetrics and Gynecology, Mithat Özsan Bulvarı Kışla Mah, 4522 Sok. No:1, Adana, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2024 Oct;301:251-257. doi: 10.1016/j.ejogrb.2024.08.029. Epub 2024 Aug 21.
To assess the reliability of placental magnetic resonance imaging measurements in predicting peripartum hysterectomy and neonatal outcomes in patients with total placenta previa.
This retrospective cohort study, conducted at a single tertiary center, identified 372 pregnant women diagnosed with placenta previa. 277 singleton pregnancies that met the inclusion criteria and were diagnosed with total placenta previa in the third trimester were divided into two groups according to whether a placental MRI was performed. Two radiologists analyzed the MRI findings of 150 pregnant women with total placenta previa. Measurements were conducted for the placental volume of the upper and lower uterine sectors, cervical canal length, and cervical canal dilatation. A comparison was made between the surgical progression of these pregnant women and 127 pregnant women with total placenta previa who did not undergo an MRI. After pathological examination, 122 (63.2%) of 193 pregnant women diagnosed with placenta accreta spectrum underwent peripartum total abdominal hysterectomy. The results were compared using logistic regression analysis.
Reduced placental volume in the upper uterine segment and increased volume in the lower uterine segment significantly correlated with a higher probability of peripartum hysterectomy (cut-off: ≤343.4 and ≥ 403.4 cm; OR: 0.993, 95 % CI: 0.990-0.995 and OR: 1.007, 95 % CI: 1.005-1.009, respectively). Shortened cervical canal length and increased dilatation raise the risk of peripartum hysterectomy (cut-off: ≤34, ≥11 mm; OR: 0.82, 95 % CI: 0.77 - 0.88 and OR: 1.7, 95 % CI: 1.4 - 2.1, respectively). The risk of neonatal death is 32 times higher in those < 34 weeks than in those 34 weeks or higher (95 % CI: 4.2-250, p = 0.001).
Placental MRI significantly contributes to predicting peripartum total abdominal hysterectomy and neonatal mortality in patients with total placenta previa associated with placenta accreta spectrum.
评估胎盘磁共振成像（MRI）测量值在预测完全性前置胎盘患者围产期子宫切除术和新生儿结局中的可靠性。
这项回顾性队列研究在一家三级中心进行，共纳入 372 例被诊断为前置胎盘的孕妇。符合纳入标准且在孕晚期被诊断为完全性前置胎盘的 277 例单胎妊娠根据是否行胎盘 MRI 分为两组。两名放射科医生分析了 150 例完全性前置胎盘孕妇的 MRI 结果。对胎盘上、下段的胎盘体积、宫颈管长度和宫颈管扩张进行了测量。比较了这些孕妇的手术进展情况和 127 例未行 MRI 的完全性前置胎盘孕妇的情况。经病理检查，193 例胎盘植入谱患者中 122 例（63.2%）在围产期行全子宫切除术。采用逻辑回归分析进行比较。
胎盘上段体积减少和下段体积增加与围产期子宫切除术的概率增加显著相关（截点：≤343.4 和≥403.4 cm；OR：0.993，95%CI：0.990-0.995 和 OR：1.007，95%CI：1.005-1.009）。宫颈管长度缩短和扩张增加与围产期子宫切除术的风险增加相关（截点：≤34，≥11 mm；OR：0.82，95%CI：0.77-0.88 和 OR：1.7，95%CI：1.4-2.1）。＜34 周的新生儿死亡率是 34 周及以上的 32 倍（95%CI：4.2-250，p=0.001）。
胎盘 MRI 显著有助于预测胎盘植入谱相关完全性前置胎盘患者的围产期全子宫切除术和新生儿死亡率。
