Department of Obstetrics and Gynecology, University of Health Sciences Adana City Training and Research Hospital, Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No:1, Adana, Turkey, Adana, Turkey.
Department of Radiology, University of Health Sciences Adana City Training and Research Hospital, Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No:1, Adana, Turkey, Adana, Turkey.
BMC Pregnancy Childbirth. 2024 Nov 25;24(1):784. doi: 10.1186/s12884-024-06996-w.
To evaluate the reliability of placental volume and other magnetic resonance imaging (MRI) markers for predicting placenta accreta spectrum and severe peripartum hemorrhage in patients with complete placenta previa.
This single-center retrospective cohort study was conducted at a tertiary care facility and included 216 pregnant women diagnosed with complete placenta previa. Two radiologists, blinded to each other's assessments, independently evaluated the prenatal placental magnetic resonance imaging (pMRI) findings of 150 singleton pregnancies that met the inclusion criteria and were delivered in the third trimester. The three-dimensional placental volume (from the S1 and S2 sectors), cervical canal length (CCL), and degree of cervical canal dilatation (CCD) were compared with clinical and pathological findings. Univariate and multivariate logistic regression analyses identified risk factors for placenta accreta spectrum (PAS) and severe peripartum hemorrhage (SPPH). Receiver operating characteristic (ROC) curve analysis determined the cutoff values of significant predictors.
Univariate analysis revealed significant risk factors for PAS, including decreased cervical canal length (odds ratio [OR] = 1.330, p < 0.001), increased cervical canal dilation (OR = 1.869, p < 0.001), decreased S1 volume (OR = 1.008, p < 0.001), and increased S2 volume (OR = 1.008, p < 0.001). Multivariate analysis confirmed that cervical canal length was an independent risk factor (odds ratio [OR] = 1.253, p = 0.03). Significant predictors of severe peripartum hemorrhage included decreased cervical canal length (odds ratio [OR] = 0.406, p = 0.006), increased cervical canal dilatation (OR = 3.22, p < 0.001), decreased S1 volume (OR = 1.079, p = 0.017), and increased S2 volume (OR = 1.032, p < 0.001), all of which were confirmed as independent risk factors. ROC analysis demonstrated high precision for MRI markers, with area under the curve values above 0.8 for critical predictors of PAS and severe peripartum hemorrhage, confirming their reliability (all p < 0.001).
This study emphasizes the pivotal role of three-dimensional placental volume measurements in the S1 and S2 sectors, along with cervical canal length and dilation, in predicting PAS and severe peripartum hemorrhage in patients with complete placenta previa. Integrating these advanced MRI markers into prenatal care can enhance early detection, improve clinical decision-making, and ultimately improve maternal and fetal outcomes.
评估胎盘体积和其他磁共振成像（MRI）标志物预测完全性前置胎盘患者胎盘植入谱系和严重围产期出血的可靠性。
这项单中心回顾性队列研究在一家三级保健机构进行，纳入了 216 名被诊断为完全性前置胎盘的孕妇。两名放射科医生独立评估了符合纳入标准并在孕晚期分娩的 150 例单胎妊娠的产前胎盘 MRI（pMRI）结果。比较了三维胎盘体积（来自 S1 和 S2 区）、宫颈管长度（CCL）和宫颈管扩张程度（CCD）与临床和病理结果。单变量和多变量逻辑回归分析确定了胎盘植入谱系（PAS）和严重围产期出血（SPPH）的危险因素。受试者工作特征（ROC）曲线分析确定了显著预测因子的截断值。
单变量分析显示，PAS 的显著危险因素包括宫颈管长度缩短（比值比 [OR] = 1.330，p < 0.001）、宫颈管扩张增加（OR = 1.869，p < 0.001）、S1 体积减少（OR = 1.008，p < 0.001）和 S2 体积增加（OR = 1.008，p < 0.001）。多变量分析证实宫颈管长度是一个独立的危险因素（比值比 [OR] = 1.253，p = 0.03）。严重围产期出血的显著预测因子包括宫颈管长度缩短（比值比 [OR] = 0.406，p = 0.006）、宫颈管扩张增加（OR = 3.22，p < 0.001）、S1 体积减少（OR = 1.079，p = 0.017）和 S2 体积增加（OR = 1.032，p < 0.001），所有这些均被确认为独立危险因素。ROC 分析显示，MRI 标志物的准确性较高，PAS 和严重围产期出血的关键预测因子的曲线下面积值均大于 0.8，证实其可靠性（均 p < 0.001）。
本研究强调了三维胎盘体积测量在 S1 和 S2 区以及宫颈管长度和扩张方面在预测完全性前置胎盘患者 PAS 和严重围产期出血中的重要作用。将这些先进的 MRI 标志物纳入产前护理可以提高早期检测的准确性，改善临床决策，并最终改善母婴结局。
