产前MRI在完全性前置胎盘患者胎盘植入及产后出血的临床价值  

Clinical value of prenatal MRI in placenta accreta and postpartum hemorrhage in patients with complete placenta previa

作　　者：姜海东 沈俊杰 王伟 张文婷 JIANG Haidong;SHEN Junjie;WANG Wei;ZHANG Wenting(Department of Radiology,The First Affiliated Hospital of Bengbu Medical University,Bengbu 233000,China;Graduate School of Medical Imaging,Bengbu Medical University,Bengbu 233000,China)

机构地区：[1]蚌埠医科大学第一附属医院放射科,安徽蚌埠233000 [2]蚌埠医科大学医学影像学院研究生院,安徽蚌埠233000

出　　处：《分子影像学杂志》2025年第4期441-445,共5页Journal of Molecular Imaging

摘　　要：目的探讨磁共振成像在完全性前置胎盘并发胎盘植入及产后出血高危因素的临床价值。方法选取2020年11月~2024年10月蚌埠医科大学第一附属医院收入的完全性前置胎盘的50例患者作为研究对象,依据病理结果将患者分为胎盘植入组(n=41)与胎盘无植入组(n=9),依据产后是否大出血将患者分为产后出血组(n=42)与无产后出血组(n=8)。分析完全性前置胎盘患者MRI征象与发生胎盘植入及产后出血的关系,采用Kappa一致性检验评估产前诊断效能。采用多因素Logistic回归模型分析MRI征象,以评估产后出血的独立危险因素。结果产前MRI征象与病理结果一致性较好(Kappa=0.675)。胎盘植入组与胎盘非植入组以及产后出血组与产后非出血的组间比较发现,除膀胱壁增厚毛糙征象,其余6个征象的差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,T2WI低信号带及子宫下段胎盘厚度2个征象是产后出血的独立危险因素(P<0.05)。结论产前MRI对胎盘植入的诊断与病理结果相符性较高。T2WI低信号带和子宫下段胎盘厚度是预测产后出血的独立危险因素,有助于为临床诊疗提供有效的预测依据。Objective To explore the clinical value of MRI in identifying high-risk factors for placenta accreta and postpartum hemorrhage in patients with complete placenta previa.Methods A total of 50 patients with complete placenta previa admitted to the First Affiliated Hospital of Bengbu Medical University from November 2020 to October 2024 were selected as the study subjects.Based on pathological results,the patients were divided into a placenta accreta group(n=41)and a non-placenta accreta group(n=9).According to the occurrence of postpartum hemorrhage,the patients were further divided into a postpartum hemorrhage group(n=42)and a non-postpartum hemorrhage group(n=8).The relationship between MRI features and the occurrence of placenta accreta and postpartum hemorrhage in patients with complete placenta previa was analyzed.The Kappa consistency test was used to evaluate the diagnostic efficacy of prenatal MRI.Multivariate logistic regression analysis was performed to assess MRI features as independent risk factors for postpartum hemorrhage.Results Prenatal MRI findings showed good consistency with pathological results(Kappa=0.675).Comparisons between the placenta accreta group and the non-placenta accreta group,as well as between the postpartum hemorrhage group and the non-postpartum hemorrhage group,revealed statistically significant differences in six out of seven MRI features(P<0.05),except for the sign of thickened and irregular bladder wall.Multivariate logistic regression analysis indicated that the T2WI low-signal band and placental thickness in the lower uterine segment were independent risk factors for postpartum hemorrhage(P<0.05).Conclusion Prenatal MRI demonstrates high consistency with pathological results in diagnosing placenta accreta.The T2WI low-signal band and placental thickness in the lower uterine segment are independent risk factors for predicting postpartum hemorrhage,providing valuable predictive insights for clinical diagnosis and treatment.

关 键 词：完全性前置胎盘 磁共振成像 胎盘植入 产后出血 

分 类 号：R714.2[医药卫生—妇产科学]