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Magnetic Resonance Image Grading of Suspected Placenta Accreta and Operative Hemorrhagic Morbidity
Abstract Number: S 25
Abstract Type: Original Research
The incidence of placenta accreta is rising, primarily due to the rise in cesarean delivery rates. Antepartum diagnosis of placenta accreta has been shown to decrease maternal hemorrhagic morbidity; however, the relationship between MRI grading of suspected accreta with estimated blood loss (EBL) and blood product transfusion has not been established. We hypothesized that grades of severity of MRI findings will correlate with hemorrhagic outcomes (EBL, transfusion requirements), which could help preoperatively stratify patients at risk for severe hemorrhage.
211 patients who delivered between Jan 2008 to Dec 2012 were identified by positive placental pathological diagnosis of “accreta,” “increta,” or “percreta.” This group was narrowed to include the 36 patients with antenatal MRI performed to evaluate for suspected abnormal placentation. 1 was excluded. MRI reports were reviewed by two dedicated body radiologists who developed and assigned a Likert scale number of 0-5 to each study, based on 24 commonly used phrases in radiology reports (e.g. “not completely excluded”=1, “diagnostic of”=5). Pathology reports and histologic slides were also reviewed and assigned a stage of 0-4, ranging from no evidence of accreta (0) to full placenta percreta (4). EBL and total blood products transfused were compared among MRI and pathologic scores using the Kruskal-Wallis test. Sensitivity of MRI score for pathologic stage was calculated. A P< 0.05 was considered significant.
45% of patients suffered hemorrhage with EBL in excess of 3 L. There was no difference in EBL (P=0.35) or blood products transfused (P=0.40) among the MRI groups. Sensitivity of MRI grade for pathologic stage was 0.55 [95% CI 0.32-0.76]. Hemorrhage in excess of 3 L correlated strongly with high-stage pathologic findings (ROC AUC = 0.71 [0.549-0.875]).
In patients with high antenatal suspicion for abnormal placentation, assigning a grade to suspected placenta accreta on MRI does not appear to predict hemorrhagic morbidity. Although antenatal MRI has been shown to be a useful complementary tool in improving diagnostic specificity and surgical preparedness, it may not be helpful to the anesthesiologist in determining patients at high risk for severe hemorrhage.
1. Khorasani R. Acad Radiol 2003;10:685–688
2. Oyelese Y. Obstet Gynecol 2006;107:927-941
3. Nguyen D. Semin Ultrasound CT MR 2012;33:65-77
4. Tikkanen M. Acta Obstet Gynecol Scand 2011;90:1140-6