PMID- 36760259
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230211
IS  - 2305-5839 (Print)
IS  - 2305-5847 (Electronic)
IS  - 2305-5839 (Linking)
VI  - 11
IP  - 1
DP  - 2023 Jan 15
TI  - Risk assessment of severe postpartum hemorrhage after invasive placenta accreta 
      based on three-dimensional reconstruction of magnetic resonance imaging.
PG  - 8
LID - 10.21037/atm-22-2940 [doi]
LID - 8
AB  - BACKGROUND: The aim of this study was to investigate the significance and 
      feasibility of risk assessments based on the three-dimensional (3D) 
      reconstruction of magnetic resonance imaging (MRI) of invasive placenta accreta 
      (IPA) to create individualized surgical protocols and perioperative management 
      plans in late pregnancy. METHODS: MRI and clinical data of 36 pregnant women with 
      IPA admitted to Southwest Hospital from January 2017 to June 2021 were 
      retrospectively analyzed. The patients were divided into the following 4 groups: 
      peripartum hysterectomy (PH), abdominal aortic balloon block (AABB), PH with 
      AABB, and nonsurgical treatment. Each group was then divided into severe and 
      nonsevere postpartum hemorrhage subgroups based on postpartum hemorrhage volumes 
      of not more than 2,000 mL and more than 2,000 mL, respectively. The uteri, 
      placentas, IPA, and urinary bladders in each group were segmented and 
      3-dimensionally reconstructed using Amira 5.2.2 (Visage Imaging, Richmond, 
      Australia) software, and their surface areas and volumes were calculated. A 
      multifactorial unconditional logistic regression analysis was performed to 
      evaluate the 3D morphological parameters of postpartum hemorrhage and calculate 
      the optimal threshold. RESULTS: The bleeding volume, IPA area, placental 
      area:uterine area ratio, IPA area:placental area ratio, maximum depth of IPA, 
      placental position score, IPA position score, and implantation volume were 
      greater in the severe postpartum hemorrhage subgroup than in the nonsevere 
      postpartum hemorrhage subgroup of all groups. In the multifactorial regression 
      analysis, the areas under the receiver operating characteristic curve of the 
      implantation area, implantation volume, maximum depth of implantation, and 
      implantation area:placental area ratio exceeded 0.9 and correlated strongly with 
      severe postpartum hemorrhage, while those of the uterine area, uterine volume, 
      placental area, placental volume, and placental area:uterine area ratio were 
      between 0.5 and 0.7 and correlated with severe postpartum hemorrhage. The 
      threshold (cutoff values) determining severe postpartum hemorrhage were 20,286.25 
      mm(2) of the implantation area, 0.01271 of the implantation area:placental area 
      ratio, 15.03 mm of the maximum depth of implantation, and 46,846 mm(3) of the 
      implantation volume. CONCLUSIONS: The MRI 3D reconstruction of IPA and its 
      adjacent structures can accurately display the location, anatomical morphology, 
      and spatial relationship of IPA, which can be used to improve the accuracy of IPA 
      diagnosis, predict postpartum hemorrhage, and provide optimized treatment 
      decisions for obstetricians.
CI  - 2023 Annals of Translational Medicine. All rights reserved.
FAU - Liu, Liqun
AU  - Liu L
AD  - Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical 
      University (Third Military Medical University), Chongqing, China.
FAU - Yan, Xiaoli
AU  - Yan X
AD  - Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical 
      University (Third Military Medical University), Chongqing, China.
FAU - Liu, Jingjing
AU  - Liu J
AD  - Department of Digital Medicine, College of Biomedical Engineering and Medical 
      Imaging, Army Medical University (Third Military Medical University), Chongqing, 
      China.
FAU - Yan, Ping
AU  - Yan P
AD  - Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical 
      University (Third Military Medical University), Chongqing, China.
FAU - Du, Mingshan
AU  - Du M
AD  - Department of Radiology, Southwest Hospital, Army Medical University (Third 
      Military Medical University), Chongqing, China.
FAU - Wang, Runyuan
AU  - Wang R
AD  - Department of Digital Medicine, College of Biomedical Engineering and Medical 
      Imaging, Army Medical University (Third Military Medical University), Chongqing, 
      China.
FAU - Wu, Yi
AU  - Wu Y
AD  - Department of Digital Medicine, College of Biomedical Engineering and Medical 
      Imaging, Army Medical University (Third Military Medical University), Chongqing, 
      China.
FAU - Wang, Dan
AU  - Wang D
AD  - Department of Obstetrics and Gynecology, Southwest Hospital, Army Medical 
      University (Third Military Medical University), Chongqing, China.
LA  - eng
PT  - Journal Article
DEP - 20230110
PL  - China
TA  - Ann Transl Med
JT  - Annals of translational medicine
JID - 101617978
PMC - PMC9906210
OTO - NOTNLM
OT  - 3D reconstruction
OT  - Magnetic resonance imaging (MRI)
OT  - invasive placenta accreta
OT  - placenta accreta spectrum
OT  - risk assessment
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available 
      at https://atm.amegroups.com/article/view/10.21037/atm-22-2940/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2023/02/11 06:00
MHDA- 2023/02/11 06:01
PMCR- 2023/01/15
CRDT- 2023/02/10 02:54
PHST- 2022/06/04 00:00 [received]
PHST- 2022/10/08 00:00 [accepted]
PHST- 2023/02/10 02:54 [entrez]
PHST- 2023/02/11 06:00 [pubmed]
PHST- 2023/02/11 06:01 [medline]
PHST- 2023/01/15 00:00 [pmc-release]
AID - atm-11-01-8 [pii]
AID - 10.21037/atm-22-2940 [doi]
PST - ppublish
SO  - Ann Transl Med. 2023 Jan 15;11(1):8. doi: 10.21037/atm-22-2940. Epub 2023 Jan 10.