MRI评估非植入型凶险性前置胎盘发生严重产后出血

MRI in evaluation of severe postpartum hemorrhage in patients with non-invasively pernicious placenta previa

目的探讨MRI评估非植入型凶险性前置胎盘发生严重产后出血的价值。方法收集114例非植入型凶险性前置胎盘患者的临床和MRI资料,分析MRI征象与严重产后出血的关系。结果单因素分析显示剖宫产次数≥2次、子宫局限性隆突、子宫下段及宫颈富血供、胎盘T2WI条状低信号、胎盘信号不均、子宫肌层变薄均易发生严重产后出血,差异有统计学差异(P均<0.05)。多变量分析示剖宫产次数≥2次(X_1)、子宫局限性隆突(X_2)、胎盘T2WI条状低信号(X_3)、胎盘信号不均(X_4)、子宫下段及宫颈富血供(X_5)发生严重产后出血的风险较大,OR值分别为8.10,10.86,3.09、2.41,7.89(P均<0.05)。5个危险因素建立的Logistic模型为Logistic(P)=-4.75+2.09X_1+2.39X_2+1.13X_3+0.88X_4+2.07X_5,该模型预测是否发生严重产后出血的准确率为89.21%。结论 MRI可预测非植入型凶险性前置胎盘发生严重产后出血的可能性。剖宫产次数≥2次、子宫局限性隆突、胎盘T2WI条状低信号、胎盘信号不均匀、子宫下段及宫颈富血供对预测是否发生严重产后出血的价值较大。

Objective To explore the value of MRI in evaluation of severe postpartum hemorrhage in patients with non-invasively pernicious placenta previa.Methods The clinical and MRI data of 114 pregnancies with non-invasively pernicious placenta previa were analyzed.The relationship between MRI features and severe postpartum hemorrhage was analyzed.Results Univariate analysis showed that the probability of severe postpartum hemorrhage was statistically significant difference between patients with non-invasively pernicious placenta previa whether had these factors or not,including previous cesarean section（n≥2）,uterine focal bulging,increased vascularity of the cervix and nearby uterine wall,dark intraplacental bands on T2 WI,heterogeneous signal intensity in the placenta and thinning myometrium（all P〈0.05）.Multivariate analysis revealed that previous cesarean section（X1,n≥2;OR = 8.10）,uterine focal bulging（X2;OR= 10.86）,dark intraplacental bands on T2WI（X3;OR = 3.09）,heterogeneous signal intensity in the placenta（X4;OR=2.41） and increased vascularity of the cervix and nearby uterine wall（X5;OR = 7.89） were associated with severe postpartum hemorrhage（all P〈0.05）.Logistic model built by these five factors was that Logistic（P） =- 4.75 ± 2.09X1 ± 2.39X2 ±1.13X3 ±0.88X4 ±2.07X5,the accuracy of prediction for severe postpartum hemorrhage was 89.21%.Conclusion MRI can be used to predict the probability of severe postpartum hemorrhage in cases of non-invasively pernicious placenta previa.It is valuable to use the features including previous multiple cesarean section,uterine focal bulging,increased vascularity of the cervix and nearby uterine wall,dark intraplacental bands on T2 WI and heterogeneous signal intensity in the placenta to predict the probability of severe postpartum hemorrhage.