| ObjectiveTo explore the value of prenatal ultrasound and MRI in the diagnosis of PASDs,and analysis the diagnostic performance of various signs.To provide more favorable evidence for clinical prenatal diagnosis of PASDs.And to study the perinatal outcome of PASDs,so as to provide a basis for weighing the risk of maternal and neonatal complications related to preterm delivery.Materials and methods1 Study objectA total of 676 patients with placenta previa at the Third Affiliated Hospital of Zhengzhou University from January 2017 to June 2019,only 165 patients met the criteria for inclusion.Intraoperative or pathological results were used as diagnostic criteria,the patients were divided into two groups:one group with placenta previa and PASDs(referred to as the accreta group),and the other group with placenta previa and non-PASDs(referred to as the non-accreta group).There were 100 cases in the accreta group and 65 cases in the non-accreta group.2 Study analysisPrenatal ultrasound and Magnetic Resonance Imaging examination information and the general information of all patients were collected,and to track and understand the intraoperative and postoperative related conditions,including blood loss at birth,postoperative hospitalization stays etc.To observe the birth and outcome of the newborn.To analyze the diagnostic value of ultrasound?MRI and combined the two methods and analyze the diagnostic value of PASDs by imaging signs of two examination methods.And to explore the effect of PASDs on puerpera and neonates according to the clinical data.3 Statistical analysisData collection was performed using the Excel form,and the entered data was analyzed using SPSS 24.0 statistical software.The measurement data were observed by x±s for normal distribution and median(M)and quartile(P25,P75)for abnormal distribution,and the independent sample t-test or Wilcoxon rank sun test was used for comparison between the two groups.The count data was expressed in frequency and rate(n,%)and analyzed by chi-square test.The test level was ?=0.05,P<0.05 was considered statistically significant.Receiver operating characteristic curve(ROC)was used to calculate the area under the curve(AUC)to analyze the detection efficiency of PASDs by the two-check method.Result1.In this study,there were 100 cases in the accreta group and 65 cases in the non-accreta group.All pregnant women chose cesarean section to terminate their pregnancy.The cesarean sections of the two groups were higher in the accreta group than in the non-accreta group,and the difference was statistically significant(P<0.05).2.Ultrasound diagnosis of PASDs was performed in 58 cases,among which 4 cases were excluded by clinical diagnosis.MRI diagnosed PASDs in 86 cases,among which 2 cases were excluded by clinical diagnosis.Both the sensitivity and coincidence rate of MRI in diagnosing PASDs were higher than that of ultrasound,and the difference was statistically significant(P<0.05).The AUC of ultrasound was 0.683(P=0.000)for all cases,and the AUC of MRI was 0.879(P=0.000)for all cases,combine two methods is 0.878(P=0.000),all of which were statistically significant.3.A total of 46 cases were missed diagnosis by ultrasound,among which 56.52%were posterior wall placenta and 30.43%were anterior wall placenta.A total of 16 cases were missed disgnosis by MRI,of which 43.75%were anterior wall placenta and 43.75%were posterior wall placenta.For anterior PASDs,the coincidence rate of MRI diagnosis was higher than that of ultrasound,and the difference was statistically significant(P<0.05).For posterior PASDs,the sensitivity and diagnostic coincidence rate of MRI were higher than that of ultrasound,and the difference was statistically significant(P<0.05).For the diagnosis of side wall PASDs,there was no significant difference between the two diagnostic methods(P>0.05).4.Four ultrasound signs used to diagnose PASDs are involved in this study:placental lacunae,loss of retroplacental clear space,myometrial thinning,and abundant blood flow signals behind placenta.The sensitivity and specificity of the loss of retroplacental clear space were 57.00%and 81.64%,while the sensitivity and specificity of the myometrial thinning were 54.00%and 89.23%,both of which were lower,suggesting significance to PASDs.Placental lacunae had good sensitivity(63.00%)and specificity(90.77%),and had good diagnostic performance.The specificity(95.38%)of abundant blood flow signals after placenta was the best.5.Five MRI signs used to diagnose PASDs are involved in this study:unclear boundary between placenta and uterine wall,thinning of the muscle layer attached to placenta,low signal shadow in the placenta of T2WI,abnormal angiogenesis in placenta,and intrauterine tissue invasion by placenta.Among them,unclear boundary between placenta and uterine wall sensitivity(87.00%)and specificity(93.85%)were higher,which had diagnostic significance for PASDs.The specificity of intrauterine tissue invasion by placenta(100%)was the highest,which had diagnostic significance for PASDs.The sensitivity and specificity of low signal shadow in the placenta of T2WI were 79.00%and 92.31%,respectively;the sensitivity and specificity of the muscle layer of placenta attachment were 63.00%and 80.00%,both lower;the specificity(95.83%)of increased vascular shadow in the placenta was higher,but the sensitivity(69.00%)was lower,suggesting significance for PASDs.6.Comparison of perinatal outcomes between the two groups.In the accreta group,49.00%of the cases termination of pregnancy between 34 and 37 weeks,slightly higher than the 44.62%of the non-accreta group.In the gestational week of delivery?37 weeks,the accreta group had a gestational week of 43.00%,slightly lower than the non-accreta group,which had a gestational week of 49.23%,but the difference between the two groups was not statistically significant(P>0.05).In the non-accreta group,65 cases of maternal bleeding were<1000ml,and 36.00%of the patients in the accreta group were?1000ml.Neonatal weight?3000g in the accreta group was 41.00%,and that in the non-accreta group was 69.23%.The NICU time of 43.00%of the newborns in the accreta group was<15 days,the NICU time of 13.00%of the newborns was?15 days,and the NICU time of 1 case(1.54%,1/65)in the non-accreta group was?15 days.Postoperative hospital stays of 81.00%of the cases in the accreta group was?7 days,lower than that in the non-acreta group(92.31%).The postoperative hospital stays was 7 to 10 days,16.00%in the accreta group was slightly higher than that in the non-accreta group(9.09%).There were statistically significant differences in blood loss,neonatal weight,NICU,postoperative hospital stay and placenta weight between the two groups(P<0.05).There was no significant difference in Apgar score between the two groups(P>0.05).Conclusion1.MRI is superior to ultrasound in the diagnosis of PASDs,especially for PASDs of posterior wall placenta.In the ultrasound signs,the placental lacunae had good diagnostic efficacy for PASDs;In MRI signs:unclear boundary between placenta and uterine wall and intrauterine tissue invasion by placenta has diagnostic significance to PASDs.2.PASDs pregnant women have increased maternal bleeding,lower newborn weight,and longer hospital stays for both mothers and infants. |
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