Effectiveness of a fetal magnetic resonance imaging scoring system for predicting the prognosis of pernicious placenta previa: A retrospective study

Abstract

Background: The value of multiple magnetic resonance imaging (MRI) signs in predicting pernicious placenta previa (PPP) with placenta accreta spectrum disorders (PAS) is still controversial. This study aimed to investigate the value of a self-made fetal magnetic resonance imaging scoring system in predicting the different types of PAS in pernicious placenta previa and its associated risk of bleeding.Methods: This retrospective study included 193 patients diagnosed with PPP based on MRI findings before delivery. Based on pathological and intraoperative findings, we divided patients into four groups: non-PAS, placental adhesion, placental implantation, and placenta percreta. Receiver operator characteristic curves of the MRI total score and placental implantation type were drawn using pROC packages in the R Studio environment, and cutoff values of each type were calculated, as well as diagnostic evaluation indexes, such as sensitivity, specificity, and the Youden index. Hemorrhage during surgery was compared between the groups.Results: The boundary value between the non-PAS and placental adhesion was 5.5, that between placental adhesion and placental implantation was 11.5, and that between placental implantation and placenta percreta was 15.5 points. The respective specificities were 0.700, 0.869, and 0.958, and the respective sensitivities were 0.994, 0.802, and 0.577. The Youden indices were 0.694, 0.671, and 0.535, respectively. The median (minimum, maximum) quantities of hemorrhage during the operation in the non-PAS, placental adhesion, placental implantation, and placenta percreta groups were 225 (100, 3700), 600 (200, 6000), 1500 (300, 7000), and 3000 (400, 6300) ml, respectively. Hemorrhage was significantly different between the four groups (p < 0.001).Conclusion: These results suggest that the proposed MRI scoring system could be an effective diagnostic tool for assessing PPP types and predicting the associated bleeding risk.

Predictive value of coagulation function, alpha-fetoprotein and placental growth factor in patients with perilous placenta previa

“…This complication represents a formidable challenge in obstetric care [13]. As indicated by data [25], nearly half of perinatal fatalities stem from postpartum hemorrhage. Historically, clinicians have evaluated the risk of PPH in PPP patients by considering variables such as maternal age, the number of cesarean deliveries, placenta previa type, and prior occurrences of placenta previa [26].…”

Enhancing postpartum hemorrhage prediction in pernicious placenta previa: a comparative study of magnetic resonance imaging and ultrasound nomogram

“…When there was disagreement, a third physician participated (TW) in the discussion and reached a consensus. The MRI and ultrasound scales were previously developed and validated by our academic group ( Zou et al, 2022 ) ( Table1 ; Table 2 ). Intraoperative blood loss was measured by weight, visual acuity, shock index, and estimated blood loss.…”

The prenatal diagnostic indicators of placenta accreta spectrum disorders

“…As with the ultrasound PAI, scholars have also proposed a scoring model using six MRI features (intraplacental T2 dark bands, intraplacental abnormal vascularity, placental bulge, heterogeneous placenta, myometrial thinning, and placental protrusion sign) to improve diagnostic performance ( Table 3 ) [ 98 ]. In addition, Zou et al constructed an MRI scoring system based on 10 MRI signs and 2 clinical features (number of previous CS, placenta location) that not only assessed the type of pernicious placenta previa, but also predicted the risk of bleeding [ 99 ]. Although these scoring models are somewhat helpful for clinical diagnosis, their acceptance and validation in clinical practice have yet to be realized.…”