磁共振成像技术在预测胎盘植入性疾病患者剖宫产术中出血量的研究

Evaluation of blood loss by magnetic resonance imaging during cesarean section in placenta accreta spectrum disorders

目的探讨磁共振成像(magnetic resonance imaging,MRI)技术预测前置胎盘合并胎盘植入患者在剖宫产术中大量出血的应用价值。方法采用回顾性研究方法,收集2015年1月至2020年12月在我院定期产检并住院分娩的161例前置胎盘合并胎盘植入患者的临床资料,按照剖宫产术中出血量分为研究组(79例,术中出血≥2000 ml)和对照组(82例,术中出血<2000 ml),分析两组患者的一般情况及MRI特征。结果两组患者的年龄、体质指数、子宫切除率和膀胱损伤率比较差异无统计学意义(P>0.05);研究组的孕次、产次和手术时间均大于对照组,差异有统计学意义(P<0.05);研究组的分娩孕周和新生儿体重均小于对照组,差异有统计学意义(P<0.05)。研究组术中出血量大于对照组[(2491.68±504.48)ml vs(997.46±421.81)ml],差异有统计学意义(P<0.05);研究组术中输血量大于对照组[(1987.58±596.94)ml vs(681.23±445.64)ml],差异有统计学意义(P<0.05)。研究组与对照组在胎盘附着位置以前壁为主(79.75%vs 30.49%)、胎盘厚度[(5.23±1.28)cm vs(4.32±1.27)cm]、宫颈长度[(2.76±0.51)cm vs(3.20±0.51)cm]、胎盘低信号面积[(7.02±1.89)cm^(2) vs(4.69±1.70)cm^(2)]、宫颈内胎盘信号(21.52%vs 6.10%)、宫颈内低信号(26.58%vs 10.98%)和膀胱内侧毛糙(18.99%vs 7.32%)方面比较,差异均有统计学意义(P<0.05);宫颈管内胎盘信号是术中大出血的最高危征象(OR=6.76,95%CI:2.44~9.27,P<0.05);联合7项MRI特征对前置胎盘合并胎盘植入患者剖宫产术中大出血预测具有较高价值(曲线下面积0.90)。结论MRI能够有效评估前置胎盘合并胎盘植入的严重程度及预测剖宫产术中大出血的风险,有利于产科医师做好充分的术前准备、减少术中出血,挽救孕产妇生命。

Objective To investigate the application value of magnetic resonance imaging in predicting massive hemorrhage in patients with placenta accreta spectrum disorders during cesarean section.Methods A total of 161 patients with placenta previa were selected who received prenatal examination and delivered in our hospital from January 2015 to December 2020.According to the amount of intraoperative blood loss,they were divided into the study group(79 cases)(intraoperative bleeding≥2000 ml)and the control group(82 cases)(intraoperative bleeding<2000 ml).The general situation and MRI characteristics of the subjects were analyzed to explore the predictive value of MRI in the severe intraoperative hemorrhage of placenta previa.Results There were no significant differences in age,body mass index,hysterectomy rate and bladder injury rate between the two groups(P>0.05).The number of pregnancies,number of births and operation time in the study group were higher than those in the control group,and the difference was statistically significant(P<0.05).The gestational age and neonatal weight of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).The amount of intraoperative blood loss in the study group was higher than that in the control group[(2491.68±504.48)ml vs(997.46±421.81)ml],and the difference was statistically significant(P<0.05).The amount of intraoperative blood transfusion in the study group was higher than that in the control group[(1987.58±596.94)ml vs(681.23±445.64)ml],and the difference was statistically significant(P<0.05).In the study group,the percentage of the placental anterior wall(79.75%vs 30.49%),placental thickness[(5.23±1.28)cm vs(4.32±1.27)cm],cervical length[(2.76±0.51)cm vs(3.20±0.51)cm],placental hyposignal area[(7.02±1.89)cm^(2) vs(4.69±1.70)cm^(2)],cervical placental signal(21.52%vs 6.10%),the low signal in the cervix(26.58%vs 10.98%),and inner bladder roughness(18.99%vs 7.32%)were higher than those in the control group,the difference was statistically significant(P<0.05).The placenta signal in the cervical canal was the most high-risk sign of intraoperative massive hemorrhage(OR=6.76,95%CI:2.44-9.27,P<0.05).Combined with seven MRI features,it is an effective method in the prediction of massive hemorrhage during cesarean section in placenta previa patients with placenta accreta(AUC=0.90).Conclusions MRI can effectively evaluate the severity of placenta previa and predict the risk of massive bleeding during cesarean section,which is beneficial to obstetricians to make full preoperative preparations,reduce intraoperative bleeding and save the lives of pregnant women.