侵入性凶险性前置胎盘腹主动脉球囊封堵下剖宫产大出血的MRI预测模型构建

目的:探讨产前MRI检查在预测侵入性凶险性前置胎盘(IPPP)产妇腹主动脉球囊封堵联合剖宫产(AABO-CS)大出血中的价值并构建MRI预测模型.方法:回顾性分析122例(粘连型23例,植入型77例,穿透型22例)经手术和/或病理证实的IPPP产妇的临床及MRI资料,根据AABO-CS术中出血量的差异将其分为大出血组和...

A MRI-based model for prediction of massive hemorrhage during abdominal aorta balloon occlusion-assis- ted cesarean section in patients with invasive pernicious placenta previa

Objective:To explore the value and construct athe performance of predictive model of the prenatal MRI in predicting massive hemorrhage during abdominal aorta balloon occlusion-assisted cesarean section(AABO-CS)in patients with invasive pernicious placenta previa(IPPP).Methods:This retrospectively study included 122 patients(23 cases with adhesion,77 cases with implantation and 22 cases with penetration)who confirmed by operation and/or pathology.The clinical and MRI data of 122 patients(23 cases with adhesion,77 cases with implantation and 22 cases with penetration)with invasive pernicious placenta previa confirmed by operation and/or pathology were analyzed retrospectively.These patients were divided into massive hemorrhage group and control group according to the amount of intraoperative hemorrhage.The independent sample t-test,Mann-Whitney U test and χ² test were tested to analysis the relationships between the amount of hemorrhage and clinical characteristics and MRI signs.The relationship between the amount of hemorrhage and clinical characteristics and MRI signs was analyzed by independent sample t-test,Mann-Whitney U test and Chi-square test.Multivariate logistic regression analysis was used to establish a regression model for the MRI signs with statistical differences in univariate analysis.The diagnostic performance of the model were analyzed using Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic(ROC)curve.The diagnostic efficacy of the model was assessed by Hosmer-Lemeshow goodness-of-fit test and receiver operating characteristic curve(ROC).Results:Univariate analysis showed significant differences in placenta percreta,placenta attachment to the lower anterior uterine wall,placental thickening,placental recess sign,intraplacental T2 dark band,focal uterine bulge,local interruption of myometrium,abnormal subserosal vascularity,abnormal intraplacental vascularity and cervical morphologic abnormalities were independent factors for between massive hemorrhage group and control group(P<0.05).Multivariate analysis showed intraplacental abnormal vascularity(X1:OR=6.971,P=0.001),subserosal abnormal vascularity(X2:OR=6.306,P=0.002),placental thickening(X3:OR=5.490,P=0.008),and cervical morphologic abnormalities(X4:OR=5.012,P=0.007)were independent risk factors for predicting intraoperative massive hemorrhage.The Logistic regression model was Logit P=-3.899+1.942X1+1.841X2+1.703X3+1.612X4.The diagnostic accuracy of the model and area under the ROC were 86.9%and 0.923(95%CI:0.873~0.972),respectively.The Hosmer-Lemeshow goodness-of-fit test showed that the model fitted well(P=0.582).When the best prediction probability was more than 45.4%,the sensitivity and specificity were 82.0%and 90.3%,respectively.Conclusion:Prenatal MRI may be useful for predicting massive hemorrhage during AABO-CS in patients with IPPP,and the MRI regression model established in this study can better quantify the bleeding risk,thus providing a reference for individualized treatment.