DIAGNOSIS OF PAS USING THE MAPI-RADS SYSTEM TO DETERMINE THE PREDICTORS OF MASSIVE BLEEDING
Kulabuhova P.V. 1, Mikheeva A.A.1, Nizyaeva N.V.1,3, Bychenko V.G.1,
Kulikov I.A.2, Shmakov R.G.1
1 - V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology
2 - Vidnovsky Perinatal Center
3 - Avtsyn research institute of human morphology, Petrovsky National Research Centre of Surgery. Moscow, Russia.
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lacenta accreta spectrum (PAS) is a dangerous complication of pregnancy, leading to the occurrence of mortality and morbidity due to massive blood loss.
Purpose. The study consisted of comparing the MAPI-RADS diagnostic algorithm with clinical data and blood loss to identify predictors of massive bleeding.
Materials and methods. The study included 56 pregnant women at risk of PAS. The division into groups was based on the MAPI-RADS system, which includes 5 classes of placenta accreta (Grade 1-5). 4 groups were distinguished: group 1 (Grade 1-2) – patients without ingrowth/with adherent placenta – 14 pregnant women (25%); group 2 (Grade 3, pl.accreta) – 18 pregnant women (32%); group 3 (Grade 4, pl. increta) – 13 pregnant women (23%); group 4 (Grade 5, pl.percreta) – 11 pregnant women (19%). MRI was performed at 26-34 weeks of gestation (30±3.42), the obtained data were compared with the intraoperative picture, followed by statistical processing of the data.
Results. As a result of the study, it was revealed that the MAPI-RADS system is applicable for the purpose of differential diagnosis of various degrees of placenta ingrowth, and there is a statistically significant difference (p=0.0003, Kruskal-Wallis-test) in the amount of blood loss in the selected groups: for group 1 up to 700 ml – 25% women (n=14); group 2 (pl.accreta) up to 800 ml – 32% women (n=18); group 3 (pl. increta) up to 1500 ml – 23% of women (n=13), group 4 (pl.percreta) over 1500 ml – 19% of women (n=11). The leading MRI predictors of massive blood loss is presence of areas with hypervascularization in the structure of the placenta and beyond in the form of vascular gaps and “ribbons” hypointense on T2WI, areas of neoangiogenesis in retroplacental region. In addition, in a number of specific changes in pl.percreta, such signs as the presence of areas of necrotic changes in the myometrium, placenta, and parametrium found in 6 women (63%) with pl.percreta were added. The second sign that occurs in all 11 women (100%) with pl.percreta is the presence of neoangiogenesis zones according to the type of vascular collateral network in the zone of the deepest ingrowth and beyond, involving the posterior wall of the bladder, isthmus and cervix, parametrium with the formation vascular shunts sweat a type of vascular malformation.
Conclusion. Thus, as a result of the study, the leading MRI predictors most often associated with deep variants of placental invasion leading to massive blood loss were identified.
Keywords: placenta pathology, pl. accreta, pl. increta, pl. percreta, MAPI-RADS, PAS, magnetic resonance imaging (MRI).
Corresponding author: Kulabuhova P.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Kulabuhova P.V., Mikheeva A.A., Nizyaeva N.V., Bychenko V.G., Kulikov I.A., Shmakov R.G. Diagnosis of pas using the mapi-rads system to determine the predictors of massive bleeding. REJR 2023; 13(3):131-143. DOI: 10.21569/2222-7415-2023-13-3-131-143.
Received: 22.03.23 Accepted: 12.07.23