Risk scoring system with MRI for intraoperative massive hemorrhage in placenta previa and accreta

Chen, Daijuan; Xu, Jinfeng; Ye, Pengfei; Li, Mier; Duan, Xia; Zhao, Fang; Liu, Xinghui; Wang, Xiaodong; Peng, Bing

doi:10.1002/jmri.26922

Cited by 28 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While formal stratification based on the described criteria was done retrospectively for study purposes, clinicians appeared to use the same information clinically in selecting timing of delivery and use of IR balloons and ureteral stents. Although mathematical modeling has been used to develop risk scores and probability cut-offs for intraoperative finding of accreta, [16][17][18] antenatal imaging remains the mainstay in predicting accreta. 10,[19][20][21][22][23] In a recent systematic review and metaanalysis, Pagani et al aimed to determine the diagnostic accuracy of ultrasound in detecting the severity of placenta accreta spectrum disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Although mathematical modeling has been used to develop risk scores and probability cut-offs for intraoperative finding of accreta, [16][17][18] antenatal imaging remains the mainstay in predicting accreta. 10,[19][20][21][22][23] In a recent systematic review and metaanalysis, Pagani et al aimed to determine the diagnostic accuracy of ultrasound in detecting the severity of placenta accreta spectrum disorders.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity

2020

View full text Add to dashboard Cite

Objective This study was aimed to compare clinical outcomes and use of interventions in women with suspected accreta based on the degree of antenatal suspicion. Study design This was a retrospective cohort study of women with suspected accreta from 2007 to 2019. Included patients had one or more imaging studies suggestive of accreta. Cases were classified as “lower risk” if imaging showed possible signs of accreta including mild or superficial myometrial infiltration, an abnormal uterine contour, an abnormal uteroplacental interface, or loss of the retroplacental hypoechoic zone and “higher risk” if there was clear evidence of more than superficial myometrial infiltration, placental tissue extruding beyond the uterine serosa, bridging vessel(s), or placental lacunae with high velocity and/or turbulent flow. The primary study outcome was a composite maternal morbidity including cesarean hysterectomy, transfusion of blood or blood products, unintentional cystotomy, or intensive care unit (ICU) admission. Chi-square, Fisher's exact test, and Mann–Whitney U-test were used for analysis. Results A total of 78 women had a suspected accreta on imaging, 36 with “lower risk” features and 42 with “higher risk” features. There were no differences in baseline maternal demographics. Women in the “higher risk” group were more likely to have a placenta previa (p < 0.01) and preoperative consultation with gynecologic oncology (p = 0.04). There was a significant difference in composite maternal morbidity between patients with “lower risk” and “higher risk” features of accreta on imaging (50 vs. 92.9%, p < 0.01). Median gestational age at planned and actual delivery were earlier in the “higher risk” group (36.6 vs. 34.9 weeks, p < 0.01; 36.0 vs. 34.7 weeks, p < 0.01). Conclusion Stratification of women with suspected accreta based on imaging corresponded to rates of maternal morbidity and operative complications, and appears to have been used clinically in selecting timing of delivery and interventions. Key Points

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Suspected Placenta Accreta: Using Imaging to Stratify Risk of Morbidity

2020

View full text Add to dashboard Cite

show abstract

“…The amount of initial bleeding is generally not much; as the gestational age increases, bleeding can occur repeatedly, and the amount of bleeding will increase. In a few cases, fatal hemorrhages occur at the first time, leading to hemorrhagic shock [ 5 ]. Placenta previa is a common condition in the third trimester of pregnancy and, if not managed properly, can endanger the life of both mother and baby.…”

Section: Introductionmentioning

confidence: 99%

Prediction for Postpartum Hemorrhage of Placenta Previa Patients through MRI Using Self-Adaptive Edge Detection Algorithm

Chen

2021

Contrast Media & Molecular Imaging

View full text Add to dashboard Cite

The study aimed to explore the application value of MRI images based on the optimized self-adaptive edge detection algorithm in the diagnosis of placenta previa and in the prediction of postpartum hemorrhage. Specifically, a self-adaptive edge detection algorithm was constructed based on optimized edge operators, with the nearest scale parameters analyzed. It was then used to process the MRI images of 36 patients with placenta previa. MRI images of different types of placenta previa were analyzed. The results found that the placenta of the complete placenta previa was attached to the lower wall of the uterus and covered the internal cervix in U shape, and the placenta adhered to the anterior and lower wall of the uterus, with widespread placenta accreta noted. With the results of cesarean section as the standard, it was observed that 2 cases of complete placenta previa were diagnosed as partial placenta previa. The diagnostic accuracy rate was 94.44%, which was not notably different from the results of cesarean section p > 0.05 . The postpartum hemorrhage rate and hysterectomy rate of complete placenta previa were higher than partial placenta previa and marginal placenta previa, and the difference was notable p < 0.05 , but no notable differences were noted in placenta adhesion, placenta accreta, neonatal death, and neonatal asphyxia between the three types of placenta previa p > 0.05 . The incidence of thinned myometrium, placenta penetrating the cervix, placenta accreta, and uneven placental signal in patients with postpartum hemorrhage was higher versus those without postpartum hemorrhage, and the difference was notable p < 0.05 . In a word, MRI images based on the self-adaptive edge detection algorithm can clearly show the status of placenta previa and exhibit better diagnosis effects and a higher accuracy rate. The thinned myometrium, the placenta penetrating the cervix, placenta accreta, and uneven placental signal may be the related risk factors for postpartum hemorrhage in patients with placenta previa.

show abstract

“…This is a pragmatic and clinically relevant approach. 9,10 Another important issue for radiologists is the management of peripartum bleeding in women with PAS. Arterial embolization has been the favored option for long.…”

mentioning

confidence: 99%