THE ABILITY OF MRI IN PREDICTING THE RISK OF MASSIVE OBSTETRIC
INTRAOPERATIVE BLEEDING IN PLACENTA ACCRETA SPECTRUM IN
PREGNANT WOMEN WITH A UTERUS SCAR
Pomortsev A.V.1,2, Kuzmenko N.N.1,2, Kuzmenko E.A.1,2,
Dyachenko Yu.Yu.1, Bukhtoyarov A.Yu.2
1 - Kuban State Medical University.
2 - Regional Clinical Hospital No. 2. Krasnodar, Russia.
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urpose. To study the diagnostic efficacy of magnetic resonance imaging in predicting the risk of massive obstetric bleeding in placental ingrowth by assessing the heterogeneity of the MR signal in the area of the lower uterine segment.
Materials and methods. A total of 103 pregnant women with signs of ingrowth were examined on ultrasound at 33-36 weeks. The studies were performed on a closed tomography scanner Vantage TITAN (Canon) with a magnetic field induction of 1.5 T. According to the formula proposed by us, the heterogeneity coefficient (patent No. 2792815 dated 03/24/2023) k=Imin\Imax* 100% was calculated. The values of the obtained coefficient were compared with intraoperative indicators of blood loss.
Results. Based on the volume of blood loss, three groups were distinguished: group 1, with a blood loss volume of up to 1000 ml (n=75), group 2, with blood loss in the range of 1000-2000 ml (n=21), and group 3, with massive obstetric bleeding, more than 2000 ml (n=7). When comparing the heterogeneity coefficient in each of the groups, statistically significant differences were found between the k1 and k2 groups, as well as between k1 and k3 (p < 0.01); There were no statistically significant differences between the K2 and K3 groups. An ROC analysis was carried out to assess the dependence of the probability of blood loss of more than 1000 ml on the value of the heterogeneity coefficient, the resulting model was statistically significant (p < 0.001) - sensitivity and specificity were 84.6% and 94.1%, respectively.
Discussion. Placenta accreta spectrum is one of the extremely serious complications of pregnancy, with the risk of massive uterine bleeding. In our study, we found a relationship between the heterogeneity of the signal from the lower uterine segment, at the level of the placenta, and the volume of blood loss during delivery. If the value of the proposed heterogeneity coefficient is less than 0.15, blood loss of more than 1000 ml is predicted.
Conclusion. The proposed method for calculating the ratio of the intensity of the MR signal in the area of the lower uterine segment in pregnant women with a scar on the uterus correlates with the volume of blood loss and allows us to assume the depth of placental invasion.
Keywords: placenta accreta spectrum, magnetic resonance imaging (MRI), obstetric hemorrhage, PAS.
Corresponding author: Kuzmenko N.N., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Pomortsev A.V., Kuzmenko N.N., Kuzmenko E.A., Dyachenko Yu.Yu., Bukhtoyarov A.Yu.. The ability of MRI in predicting the risk of massive obstetric intraoperative bleeding in placenta accreta spectrum in pregnant women with a uterus scar. REJR 2024; 14(2):69-76. DOI: 10.21569/2222-7415-2024-14-2-69-76.
Received: 25.01.24 Accepted: 13.03.24