Clinical Utility of the Prenatal Ultrasound Score of the Placenta Combined with Magnetic Resonance Imaging in Diagnosis of Placenta Accreta during the Second and Third Trimester of Pregnancy

Abstract

Objective. The aim is to explore the clinical utility of the prenatal ultrasound score of the placenta combined with magnetic resonance imaging (MRI) in diagnosis of placenta accreta during the second and third trimester of pregnancy. Materials and Methods. A total of 108 pregnant women with suspected placenta accreta treated in Wuhan Hankou Hospital and Yantaishan Hospital of Yantai from January 2019 to January 2022 were retrospectively analyzed, the enrolled pregnant women received MRI examination because of suspected results of ultrasonic diagnosis, and by taking pathologic findings as the gold standard, the diagnostic efficacy of the ultrasound score, MRI, and their combination to placenta accreta during the second and third trimester of pregnancy was analyzed, and the diagnostic sensitivity, specificity, the positive predictive value, and the negative predictive value of these diagnostic modalities were evaluated. Results. Among 108 patients with suspected placenta accreta, 75 with pathologically confirmed placenta accreta were included in the accreta group, and 33 without placenta accreta were included in the non-accreta group; no statistical between-group differences in the patients’ age, gestational weeks, educational degree, and other general data were observed ( P > 0.05 ), but the history of cesarean section, history of induced abortion, and incidence rate of placenta praevia were significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the ultrasound score was significantly higher in the accreta group than in the non-accreta group ( P < 0.05 ); the incidence rates of signs of “placental heterogeneity” and “bulge of lower segment of the uterus and local thickening of the placenta” were obviously higher in the accreta group than in the non-accreta group ( P < 0.05 ); according to the comparison with pathologic findings, the accuracy rate, sensitivity, specificity, the positive predictive value, and the negative predictive value of combined diagnosis were significantly higher than those of single application of the ultrasound score and MRI diagnosis ( P < 0.05 ); and ROC analysis found that the area under the curve of combined diagnosis was obviously larger than that of the ultrasound score and MRI diagnosis ( P < 0.05 ). Conclusion. A combining prenatal ultrasound score of the placenta with MRI plays an important role in the diagnosis of placenta accreta during the second and third trimester of pregnancy, which can further improve the diagnostic accuracy rate of placenta accreta and provide significant guidance in preventing high-risk complications during the perinatal period.

Value of early pregnancy ultrasound combined with ultrasound score in the evaluation of placenta accreta in scar uterus: A retrospective cohort study

“…This shows that ultrasound examination can determine whether PA occurs in patients using relevant imaging features, which is consistent with the findings of this study. However, conventional ultrasound examination is easily affected by subjective factors and clinical experience, and the ultrasound scoring system can compensate for its shortcomings [12,13] Chen et al [17] explored the evaluation value of the ultrasound scoring system in the treatment of PA disease; according to different USSs, patients with PA were divided into low, medium, and high groups, and the results showed that the risk of bleeding increased with an increase in USS, indicating that the ultrasound scoring system has high application value in the diagnosis and treatment of PA. Zhang et al [14] Table 2 Comparison of baseline data between 2 groups.…”

“…This shows that ultrasound examination can determine whether PA occurs in patients using relevant imaging features, which is consistent with the findings of this study. However, conventional ultrasound examination is easily affected by subjective factors and clinical experience, and the ultrasound scoring system can compensate for its shortcomings [ 12 , 13 ] Chen et al [ 17 ] explored the evaluation value of the ultrasound scoring system in the treatment of PA disease; according to different USSs, patients with PA were divided into low, medium, and high groups, and the results showed that the risk of bleeding increased with an increase in USS, indicating that the ultrasound scoring system has high application value in the diagnosis and treatment of PA. Zhang et al [ 14 ] discussed the application value of prenatal placental USS in PA in the second and third trimesters of pregnancy, and the results showed that the USSs of patients with PA were significantly higher than those of patients without PA; the negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of disease diagnosis can be significantly improved by combining MRI with USS. The results of this study also showed that the sensitivity and accuracy of combined diagnosis were significantly higher than those of conventional ultrasound examination and slightly higher than the evaluation of USS, but there was no significant difference between the two groups.…”

“…For the ultrasonic diagnosis of PA, refer to the diagnostic criteria of the guidelines for the diagnosis and treatment of PA (2015): the normal structure of the placental site is disordered, the normal hypoechoic area behind the placenta disappears or becomes thinner, the blood vessels at the junction of the uterine serosa and bladder are rich, and there is focal or diffuse intraluminal BF in the placental parenchyma. [13] For pathological diagnosis of placenta accrete, it was referred to the study by Zhang et al [14] Table 1 Ultrasonic scoring scale of scar uterus placenta implantation.…”