Evaluation of blood loss by magnetic resonance imaging during cesarean section in placenta accreta spectrum disorders

doi:10.3877/cma.j.issn.2095-3259.2023.03.010

Abstract

Abstract:

Objective

To investigate the application value of magnetic resonance imaging in predicting massive hemorrhage in patients with placenta accreta spectrum disorders during cesarean section.

Methods

A total of 161 patients with placenta previa were selected who received prenatal examination and delivered in our hospital from January 2015 to December 2020. According to the amount of intraoperative blood loss, they were divided into the study group (79 cases) (intraoperative bleeding ≥2000 ml) and the control group (82 cases) (intraoperative bleeding <2000 ml). The general situation and MRI characteristics of the subjects were analyzed to explore the predictive value of MRI in the severe intraoperative hemorrhage of placenta previa.

Results

There were no significant differences in age, body mass index, hysterectomy rate and bladder injury rate between the two groups (P>0.05). The number of pregnancies, number of births and operation time in the study group were higher than those in the control group, and the difference was statistically significant (P<0.05). The gestational age and neonatal weight of the study group were lower than those of the control group, and the differences were statistically significant (P<0.05). The amount of intraoperative blood loss in the study group was higher than that in the control group [(2491.68±504.48)ml vs (997.46±421.81)ml], and the difference was statistically significant (P<0.05). The amount of intraoperative blood transfusion in the study group was higher than that in the control group [(1987.58±596.94)ml vs (681.23±445.64)ml], and the difference was statistically significant (P<0.05). In the study group, the percentage of the placental anterior wall (79.75% vs 30.49%), placental thickness[(5.23±1.28)cm vs (4.32±1.27)cm], cervical length[(2.76±0.51)cm vs (3.20±0.51)cm], placental hyposignal area[(7.02±1.89)cm² vs (4.69±1.70)cm²], cervical placental signal(21.52% vs 6.10%), the low signal in the cervix(26.58% vs 10.98%), and inner bladder roughness(18.99% vs 7.32%) were higher than those in the control group, the difference was statistically significant (P<0.05). The placenta signal in the cervical canal was the most high-risk sign of intraoperative massive hemorrhage (OR=6.76, 95%CI: 2.44-9.27, P<0.05). Combined with seven MRI features, it is an effective method in the prediction of massive hemorrhage during cesarean section in placenta previa patients with placenta accreta (AUC=0.90).

Conclusions

MRI can effectively evaluate the severity of placenta previa and predict the risk of massive bleeding during cesarean section, which is beneficial to obstetricians to make full preoperative preparations, reduce intraoperative bleeding and save the lives of pregnant women.

Key words: Placenta previa, Placenta accreta, Magnetic resonance imaging, Cesarean section, Hemorrhage

Yongfei Yue, Liping Zhu, Xiaoyan Wang. Evaluation of blood loss by magnetic resonance imaging during cesarean section in placenta accreta spectrum disorders[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2023, 12(03): 167-172.

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References 18

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组别	例数	年龄(岁，±s)	体质指数(kg/m²，±s)	孕次(次，±s)	产次(次，±s)	分娩孕周(周，±s)	手术时间(min，±s)	子宫切除例(%)	膀胱损伤例(%)	新生儿体重(g，±s)
研究组	79	31.92±3.91	26.34±3.34	3.38±1.29	1.87±0.56	35.45±1.13	96.58±30.65	3(3.80)	3(3.80)	2450.60±391.46
对照组	82	31.38±3.88	26.47±4.64	2.83±1.36	1.57±0.59	36.34±1.03	67.69±35.02	0(0.00)	1(1.22)	2681.10±345.40
统计值		t＝0.89	t＝0.20	Z＝2.63	Z＝3.31	t＝5.24	t＝6.24	χ²＝3.17	χ²＝1.10	t＝3.96
P值		0.38	0.85	0.01	<0.01	<0.01	<0.01	0.08	0.29	<0.01

组别	例数	年龄(岁，±s)	体质指数(kg/m²，±s)	孕次(次，±s)	产次(次，±s)	分娩孕周(周，±s)	手术时间(min，±s)	子宫切除例(%)	膀胱损伤例(%)	新生儿体重(g，±s)
研究组	79	31.92±3.91	26.34±3.34	3.38±1.29	1.87±0.56	35.45±1.13	96.58±30.65	3(3.80)	3(3.80)	2450.60±391.46
对照组	82	31.38±3.88	26.47±4.64	2.83±1.36	1.57±0.59	36.34±1.03	67.69±35.02	0(0.00)	1(1.22)	2681.10±345.40
统计值		t＝0.89	t＝0.20	Z＝2.63	Z＝3.31	t＝5.24	t＝6.24	χ²＝3.17	χ²＝1.10	t＝3.96
P值		0.38	0.85	0.01	<0.01	<0.01	<0.01	0.08	0.29	<0.01

组别	例数	胎盘位置前壁为主[例(%)]	胎盘厚度(cm，±s)	宫颈长度(cm，±s)	胎盘低信号面积(cm²，±s)	宫颈内胎盘信号例(%)	宫颈内低信号例(%)	膀胱内侧毛糙例(%)
研究组	79	63(79.75)	5.23±1.28	2.76±0.51	7.02±1.89	17(21.52)	21(26.58)	15(18.99)
对照组	82	25(30.49)	4.32±1.27	3.20±0.51	4.69±1.70	5(6.10)	9(10.98)	6(7.32)
统计值		χ²＝39.39	t＝4.58	t＝5.42	t＝8.22	χ²＝8.11	χ²＝6.46	χ²＝4.83
P值		<0.01	<0.01	<0.01	<0.01	0.01	0.01	0.03

组别	例数	胎盘位置前壁为主[例(%)]	胎盘厚度(cm，±s)	宫颈长度(cm，±s)	胎盘低信号面积(cm²，±s)	宫颈内胎盘信号例(%)	宫颈内低信号例(%)	膀胱内侧毛糙例(%)
研究组	79	63(79.75)	5.23±1.28	2.76±0.51	7.02±1.89	17(21.52)	21(26.58)	15(18.99)
对照组	82	25(30.49)	4.32±1.27	3.20±0.51	4.69±1.70	5(6.10)	9(10.98)	6(7.32)
统计值		χ²＝39.39	t＝4.58	t＝5.42	t＝8.22	χ²＝8.11	χ²＝6.46	χ²＝4.83
P值		<0.01	<0.01	<0.01	<0.01	0.01	0.01	0.03

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