基于MRI预测前置胎盘合并胎盘植入及产后出血的价值研究

Value of MRI in Predicting Placenta Previa with Placenta Implantation and Postpartum Hemorrhage

目的 探讨MRI预测前置胎盘合并胎盘植入及产后出血的临床应用价值。方法 回顾性分析经剖宫产术中证实或病理诊断明确,且临床资料及产前MRI影像学资料完整的前置胎盘患者228例,根据术后病理分为无胎盘植入组(n=102)及有胎盘植入组(n=126);另根据是否有产后出血分为无产后出血组(n=149)及产后出血组(n=79),采用χ^(2)检验或Fisher确切概率法比较两组之间MRI征象的表现差异。运用Kappa一致性检验评估产前MRI诊断胎盘植入的诊断效能,多因素Logistic回归模型分析MRI征象评估产后出血的独立危险因素。结果无胎盘植入组及有胎盘植入组MRI征象比较,除胎盘缺血梗死征象外,其余9项MRI征象表现差异均有统计学意义(P<0.05)。产前MRI诊断结果与剖宫产术中所见及术后病理诊断结果一致性较好(Kappa=0.817)。无产后出血组及产后出血组MRI征象比较,除胎盘缺血梗死征象外,其余9项MRI征象差异均有统计学意义(P<0.05)。运用Logistic回归模型进行多因素分析,结果显示胎盘内异常胎儿血管宽度及胎盘前壁覆盖至膀胱顶部以下两项征象差异具有统计学意义(P<0.05)。结论 MRI产前诊断胎盘植入与剖宫产术后病理诊断结果一致性较高,且对于预测产后出血具有一定的临床应用价值。

Objective To investigate the clinical application value of magnetic resonance imaging(MRI)in predicting placenta previa with placenta accreta and postpartum hemorrhage.Methods A total of 228 patients with placenta previa confirmed by cesarean section or pathology were retrospectively analyzed for complete clinical data and prenatal MRI imaging data,and were divided into two groups:one without placenta accreta(n=102)and one with placenta accreta(n=126).They were also divided into two groups according to the presence or absence of postpartum hemorrhage(n=149)and postpartum hemorrhage(n=79).The differences in MRI findings between the two groups were compared by χ^(2) test or Fisher exact probability method.Kappa consistency test was used to evaluate the diagnostic efficacy of MRI in the diagnosis of placenta implantation before delivery,and multivariate Logistic regression model was used to analyze the independent risk factors of MRI signs in the evaluation of postpartum hemorrhage.Results There were statistical significance in MRI findings between the group without placenta implantation and the group with placenta implantation,except for placenta ischemic infarction(P<0.05).The results of prenatal MRI diagnosis were in good agreement with those seen in cesarean section and postoperative pathological diagnosis(Kappa=0.817).In addition to placental ischemic infarction,the other nine MRI signs were statistically significant(P<0.05).Logistic regression model was used for multivariate analysis,and the results showed that the abnormal fetal blood vessel width in the placenta and the anterior wall of the placenta covering below the top of the limb were statistically significant(P<0.05).Conclusion MRI diagnosis of placenta implantation in prenatal is consistent with pathological diagnosis after cesarean section,and has certain clinical application value in predicting postpartum hemorrhage.