Zhang Shimao, Li Xin, Jin Ying, Cheng Linbo, Wu Tenglan, Hou Xi, Wei Sumei, Li Yalan, Xiao Xue, Liu Tianjiao, Wang Luying
Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
Heliyon. 2024 Aug 17;10(17):e36480. doi: 10.1016/j.heliyon.2024.e36480. eCollection 2024 Sep 15.
The prenatal detection of placenta accreta spectrum (PAS) disorder is crucial for treatment strategy formulation. MRI descriptors may offer a more objective method for predicting PAS and clinical outcomes. The aim of this study is to investigate the predictive value of MRI examination for intraoperative blood loss in PAS cesarean section and elucidating the MRI descriptors that are more valuable for predicting intraoperative blood loss.
A prospective study was carried out on 164 pregnant women diagnosed with PAS. Maternal and neonatal perioperative characteristics were systematically collected. To evaluate the relationship between maternal and perioperative characteristics and intraoperative blood loss, as well as the predictive value of MRI descriptors on intraoperative blood loss, a multivariable linear regression analysis was performed.
Patients were pre-grouped based on a combined ultrasound-MRI evaluation, with 108 cases (65.9 %) classified as placenta accreta, 47 cases (28.7 %) as placenta increta, and 9 cases (5.4 %) as placenta percreta. The results demonstrated that intraoperative blood loss was positively associated with partial MRI descriptors (F = 9.751, df = 15), such as placenta accreta (OR: 243.33, p = 0.006), cross-border blood vessels that pass through the uterine muscle layer (OR: 297.76, p = 0.012), interruption of hyperechoic uterus-bladder interface (bladder line) (OR: 342.59, p = 0.011), and subplacental hypervascularity (OR: 365.96, p = 0.027).
Preoperative MRI demonstrates promising predictive capabilities in estimating intraoperative blood loss for PAS patients. Pregnant women identified as having a high risk of intraoperative bleeding based on MRI findings should undergo closer antenatal monitoring in late pregnancy, along with more comprehensive preoperative blood preparation, to better ensure maternal and fetal safety.
产前检测胎盘植入谱系障碍（PAS）对于制定治疗策略至关重要。MRI描述符可能为预测PAS及临床结局提供更客观的方法。本研究旨在探讨MRI检查对PAS剖宫产术中失血的预测价值，并阐明对预测术中失血更有价值的MRI描述符。
对164例诊断为PAS的孕妇进行前瞻性研究。系统收集孕产妇和新生儿围手术期特征。为评估孕产妇和围手术期特征与术中失血之间的关系，以及MRI描述符对术中失血的预测价值，进行多变量线性回归分析。
根据超声-MRI联合评估对患者进行预分组，108例（65.9%）诊断为胎盘粘连，47例（28.7%）为胎盘植入，9例（5.4%）为穿透性胎盘植入。结果表明，术中失血与部分MRI描述符呈正相关（F = 9.751，自由度 = 15），如胎盘粘连（OR：243.33，p = 0.006）、穿过子宫肌层的跨界血管（OR：297.76，p = 0.012）、高回声子宫-膀胱界面（膀胱线）中断（OR：342.59，p = 0.011）和胎盘下血管增多（OR：365.96，p = 0.027）。
术前MRI在估计PAS患者术中失血方面显示出有前景的预测能力。根据MRI结果确定为术中出血高风险的孕妇，在妊娠晚期应接受更密切的产前监测，并进行更全面的术前备血，以更好地确保母婴安全。
