Correlation of Probability Scores of Placenta Accreta on Magnetic Resonance Imaging With Hemorrhagic Morbidity

Lim, Grace; Horowitz, Jeanne M.; Berggruen, Senta; Ernst, Linda M.; Linn, Rebecca L.; Hewlett, B.; Kim, J.; Chalifoux, Laurie A.; McCarthy, Rose-Lynn

doi:10.1097/01.aoa.0000515758.57898.88

Cited by 3 publications

(6 citation statements)

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“…With a sensitivity of 96% for predicting hysterectomy, specific cutoff values have been proposed: 3.5 for the placenta accreta index derived from ultrasound, and 2.5 cm for the maximum dimension of invasion as determined by magnetic resonance imaging [27]. All our patients had an MRI because it allows us to better study the insertion of the placenta accreta [26].…”

Section: Resultsmentioning

confidence: 99%

WITHDRAWN: Modified one-step conservative surgery for placenta accreta spectrum versus caesarean hysterectomy: The CMNT PAS prospective comparative Non-Randomized pilot study

Abouda,

Aloui,

Marzouk

et al. 2024

Preprint

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Introduction: The surgical procedure known as one-step conservative surgery for placenta accreta spectrum involves the excision of the placenta and its attachment site on the myometrium. We aimed to conduct a non-randomized comparative study between conservative surgical treatment of placenta accreta spectrum and classical caesarean hysterectomy, under the name of the "CMNT PAS" study. To determine the sample size and the expected difference between the two groups, we conduct this pilot study. Study design: It was a monocentric prospective observational study from January 4, 2020, to August 17, 2022. Patients were allocated into two groups: Group Conservative Surgery (CSG) in which the method detailed in prior research by Palacios-Jaraquemada was slightly modified by our team, control group (CG) when the caesarean hysterectomy was performed. Results: Our main goal is to determine the sample size for our principal study and provide adequate data for any other team wishing to study the conservative surgical treatment of placenta accreta spectrum. So, the sample size for a power of 90% and an alpha risk of 5%, the size of each group must be 22 patients. Regarding primary outcomes: estimated blood loss volume was lower in CG compared to CSG but not statistically significant. Conclusion: Our pilot study found that the caesarean hysterectomy is similar to conservative surgical treatment for placenta accreta in estimated blood loss. However, the latter helps preserve uterus and possibly fertility.

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Section: Resultsmentioning

confidence: 99%

WITHDRAWN: Modified one-step conservative surgery for placenta accreta spectrum versus caesarean hysterectomy: The CMNT PAS prospective comparative Non-Randomized pilot study

Abouda,

Aloui,

Marzouk

et al. 2024

Preprint

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“…In our study, we also found an association of the previously reported MRI signs with severe blood loss and hysterectomy performance. However, in accordance with data from clinical studies, 24 we decided to use a higher cutoff value (>2000 ml) to define severe/massive hemorrhage. In addition to profound blood loss, we included other adverse clinical events that may occur during delivery and further compromise maternal peripartum outcome: bladder wall repair, prolonged operation time, and admission to the ICU.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have proposed MRI scores for the diagnosis of abnormal placentation, 34,35 but the association of these scores with poor pregnancy outcomes has not been tested. In a recent study, 24 the authors describe a method of assigning scores to MRI reports based on degrees of probability for the diagnosis of placental invasiveness; the produced MRI score failed to correlate with patients' hemorrhagic morbidity.…”

Section: Discussionmentioning

confidence: 99%

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MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

Bourgioti

Zafeiropoulou

Fotopoulos

et al. 2018

Magnetic Resonance Imaging

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Background Placenta accreta spectrum (PAS) disorders may be associated with significant mortality and morbidity for both mother and fetus. Purpose/Hypothesis To identify MRI risk factors for poor peripartum outcome in gravid patients at risk for PAS. Study Type Prospective. Population One hundred gravid women (mean age: 34.9 years) at third trimester, with placenta previa. Field Strength/Sequence T2‐SSTSE (single‐shot turbo spin echo), T2‐TSE, T1‐TSEFS (TSE images with fat‐suppression) at 1.5T. Assessment Fifteen MRI features considered indicative of PAS were recorded by three radiologists and were tested for any association with the following adverse peripartum maternal and neonatal events: increased operation time, profound blood loss, hysterectomy, bladder repair, ICU admission, prematurity, low birthweight, and 5‐minute APGAR score <7. Statistical Tests Kappa (K) coefficients were computed as a measure of agreement between intraoperative information/histology and MRI results as well as for interobserver agreement; chi‐square and Fisher's exact tests were used to explore the association of the MRI signs with clinical complications. A score was calculated by adding all recorded MRI signs and its predictive ability was tested using receiver operating characteristic (ROC) analysis, against all complications, separately; odds ratios (ORs) for optimal cutoffs were determined with logistic regression analysis. Results There was excellent agreement (K >0.75, P < 0.001) between MRI and intraoperative findings for invasive placenta, bladder and parametrial involvement. Intraplacental T2 dark bands, myometrial disruption, uterine bulge, and hypervascularity at the utero‐placental interface or parametrium, showed significant association (P < 0.005) with poor clinical outcome for both mother and fetus. The MRI score showed significant predictive ability for each adverse maternal event (area under the curve [AUC]: 0.85–0.97, P < 0.001). The presence of ≥3 MRI signs was the cutoff point for a complicated delivery (OR: 19.08, 95% confidence interval [CI]: 6.05–60.13) and ≥6 MRI signs was the cutoff point for massive bleeding (OR: 90.93, 95% CI: 11.3–729.23), hysterectomy (OR: 72.5, 95% CI: 17.9–293.7), or extensive bladder repair (OR: 58.74, 95% CI: 7.35–469.32). The MRI score was not significant for predicting adverse neonatal events including preterm delivery (P = 0.558), low birthweight (P = 0.097), and 5‐minute Apgar score (P = 0.078). Data Conclusion Preoperative identification of specific MRI features may predict peripartum course in high‐risk patients for PAS. Level of Evidence: 1 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:602–618.

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“…This scoring system may be useful for predicting the risk of placenta accreta, but it does not reflect the risk of antenatal bleeding. Recently, many attempts have been made to detect the extent of placental invasion through uterine muscle layer through magnetic resonance image (MRI) [6,10,11]. However, the cost and inconvenience of MRI should be considered.…”

Section: Discussionmentioning

confidence: 99%

The Risk Factors for Antenatal Bleeding in Pregnancy with Placenta Previa

Cho¹

2017

J Preg Child Health

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Objective: The majority of previa-related bleeding is due to an adhesive placenta. The risk factors are already well known. Although antenatal bleeding in women with placenta previa is another problem, the risk factors have not been identified. Our aim is to investigate the risk factors for antenatal bleeding in women with placenta previa. Methods:This was a retrospective study of postpartum women who received an ultrasound diagnosis of placenta previa. Included women were divided into two groups based on whether they had antenatal bleeding or not. Sonographic images were reviewed. Parameters assessed included loss of the retroplacental clear zone, irregularity of uterine-bladder interface, number of lacunar spaces, vasa previa and increased vascularity around placenta. We also assessed the type of placenta previa, placenta location, cervical length at third trimester and obstetric histories. Statistical analyses were performed using a t-test, X 2 test and logistic regression test. Results:Of 109 patients included, 55 (50.5%) experienced antenatal bleeding. There was no significant difference in maternal age between the two groups (P=0.903). Obstetric histories, cervical length at third trimester and sonographic findings were not significantly different. Conclusion:Prediction of antenatal bleeding in placenta previa using obstetrical history and sonographic finding is difficult.

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Correlation of Probability Scores of Placenta Accreta on Magnetic Resonance Imaging With Hemorrhagic Morbidity

Cited by 3 publications

References 3 publications

WITHDRAWN: Modified one-step conservative surgery for placenta accreta spectrum versus caesarean hysterectomy: The CMNT PAS prospective comparative Non-Randomized pilot study

WITHDRAWN: Modified one-step conservative surgery for placenta accreta spectrum versus caesarean hysterectomy: The CMNT PAS prospective comparative Non-Randomized pilot study

MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders

The Risk Factors for Antenatal Bleeding in Pregnancy with Placenta Previa

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