Placenta accreta spectrum in major placenta previa diagnosed only by MRI: incidence, risk factors, and maternal morbidity.

IF 1.5 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Saudi Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-03 DOI:10.5144/0256-4947.2023.219
Ayman Hussien Shaamash, Mehad H AlQasem, Deama S Al Ghamdi, Ahmed A Mahfouz, Mamdoh A Eskandar
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引用次数: 0

Abstract

Background: Antenatal assessment of maternal risk factors and imaging evaluation can help in diagnosis and treatment of placenta accreta spectrum (PAS) in major placenta previa (PP). Recent evidence suggests that magnetic resonance imaging (MRI) could complement ultrasonography (US) in the PAS diagnosis.

Objectives: Evaluate the incidence, risk factors, and maternal morbidity related to the MRI diagnosis of PAS in major PP.

Design: A 10-year retrospective cohort study.

Setting: Tertiary care hospital.

Patients and methods: We report on patients with major PP who had cesarean delivery in Abha Maternity and Children's Hospital (AMCH) over a 10-year period (2012-2021). They were evaluated with ultrasonography (US) and color Doppler for evidence of PAS. Antenatal MRI was ordered either to confirm the diagnosis (if equivocal US) or to assess the depth of invasion/extra-uterine extension (if definitive US).

Main outcome measures: Risk factors for PAS in major PP and maternal complications.

Sample size: 299 patients RESULTS: Among 299 patients, MRI confirmed the PAS diagnosis in 91/299 (30.5%) patients. The independent risk factors for MRI diagnosis of PAS in major PP included only repeated cesarean sections and advanced maternal age. The commonest maternal morbidity in major PP with PAS was significantly excessive intraoperative bleeding.

Conclusion: MRI may be a valuable adjunct in the evaluation of PAS in major PP; as a complement, but not substitute US. MRI may be suitable in major PP/PAS patients who are older and have repeated cesarean deliveries with equivocal results or deep/extra-uterine extension on US.

Limitation: Single center, small sample size, lack of complete histopathological diagnosis.

Conflict of interest: None.

仅通过MRI诊断的主要前置胎盘植入频谱:发病率、危险因素和母体发病率。
背景:产前评估母体危险因素和影像学评估有助于诊断和治疗主要前置胎盘(PP)的胎盘植入谱(PAS)。最近的证据表明,磁共振成像(MRI)可以补充超声(US)在PAS诊断中的作用。目的:评估主要PP中PAS的MRI诊断相关的发病率、危险因素和母体发病率。设计:一项10年回顾性队列研究。设置:三级护理医院。患者和方法:我们报告了在10年期间(2012-2021年)在阿布哈妇幼医院(AMCH)进行剖宫产的重度PP患者。通过超声(US)和彩色多普勒对PAS的证据进行评估。产前MRI被要求要么确认诊断(如果US不明确),要么评估侵犯/子宫外扩张的深度(如果US明确)。主要转归指标:主要PP和母体并发症中PAS的危险因素。样本量:299名患者结果:在299名患者中,91/299名(30.5%)患者的MRI证实了PAS诊断。MRI诊断主要PP PAS的独立危险因素仅包括重复剖宫产和高龄产妇。患有PAS的主要PP中最常见的产妇发病率是术中出血过多。结论:MRI可能是评估主要PP患者PAS的一种有价值的辅助手段;作为一种补充,但不能替代US。MRI可能适用于年龄较大、多次剖宫产且结果不明确或US子宫深部/子宫外扩张的主要PP/PAS患者。局限性:单中心,样本量小,缺乏完整的组织病理学诊断。利益冲突:无。
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来源期刊
Annals of Saudi Medicine
Annals of Saudi Medicine 医学-医学:内科
CiteScore
2.80
自引率
0.00%
发文量
44
审稿时长
4-8 weeks
期刊介绍: The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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