胎盘植入孕妇产后出血的磁共振特征

目的：探讨胎盘植入疾病（PAS）患者剖宫产后发生产后出血的MRI特征,分析其危险因素。方法：回顾性分析2016 年9月至2021年3月在温州医科大学附属台州医院行产前胎盘MRI检查并分娩的100 例PAS患者的临床资料及MRI图像,将产后出血量≥1 000 mL的37例PAS患者作为观察组（包括发生子宫切除者16例）,出血量＜1 000 mL的63例PAS患者作为对照组。比较两组的MRI特征（包括T2W胎盘内低信号带、胎盘/子宫膨出、T2W胎盘后低信号线消失、子宫肌层变薄、膀胱壁中断、局部外生团块、胎盘床异生血管以及前置胎盘、凶险性前置胎盘）差异,分析评估发生产后出血的独立危险因素。结果：两组间比较,除子宫肌层变薄之外的8 个MRI特征差异均有统计学意义（P ＜0.05）,二元Logistic回归分析显示T2W胎盘内低信号带（OR =10.889,95%CI：1.021～116.159）、凶险性前置胎盘（OR =5.458,95%CI：1.284～23.200）是PAS患者发生术中出血的独立危险因素（P ＜0.05）。结论：产前MRI出现T2W胎盘内低信号带及凶险性前置胎盘提示PAS孕妇产后出血风险高。

MRI features of postpartum hemorrhage in gravida with placenta accreta sepctrum

Objective: To investigate the MRI features of gravida with PAS with an analysis of the risk factors of postpartum hemorrhage after cesarean section. Methods: The clinical data and MRI images of 100 gravida with PAS who underwent prenatal MRI examination and delivered in Taizhou Hospital Affiliated to Wenzhou Medical University from September 2016 to March 2021 were retrospectively analyzed. Thirty-seven gravida with postpartum hemorrhage≥1 000 mL were selected as the observation group (including 16 patients with hysterectomy), and 63 gravida with blood loss less than 1 000 mL were selected as the control group. The differences of MRI features between the two groups were compared, including T2-dark intraplacenta bands,placental/uterine bulge, loss of retroplacental T2-hypointense, myometrium thinning, bladder wall interruption,focal exophytic mass, abnormal vascularization of placental bed, placenta previa and catastrophe placenta previa,and the independent risk factors of postpartum hemorrhage were analyzed and evaluated. Results: There was statistical difference between the two groups in 8 MRI features except myometrium thinning (P<0.05). Binary Logistic regression analysis showed that T2-dark intraplacenta bands (OR=10.889, 95%CI: 1.021-116.159) and catastrophe placenta previa (OR=5.458, 95%CI: 1.284-23.200) were independent risk factors for postpartum hemorrhage in gravida with PAS (P<0.05). Conclusion: T2-dark intraplacenta bands and catastrophe placenta previa on prenatal MRI prompted an increased risk of postpartum hemorrhage in gravida with PAS, which should be paid attention to by obstetrician.