The following is a summary of “Diagnostic Accuracy of Magnetic Resonance Imaging to Predict Peripartum Hysterectomy and Neonatal Mortality in Total Placenta Previa: A retrospective cohort study,” published in the August 2024 issue of Obstetrics and Gynecology by Kükrer et al.
This study aimed to evaluate the reliability of placental magnetic resonance imaging (MRI) measurements in predicting peripartum hysterectomy and neonatal outcomes in patients diagnosed with total placenta previa. This retrospective cohort study was conducted at a single tertiary center, which included 372 pregnant women diagnosed with placenta previa. Of these, 277 singleton pregnancies with total placenta previa in the third trimester met the inclusion criteria and were divided into two groups based on whether they underwent placental MRI.
Two radiologists analyzed MRI findings for 150 patients, focusing on measurements of placental volume in the upper and lower uterine segments, cervical canal length, and cervical canal dilatation. These results were compared to 127 patients who did not receive an MRI. Out of 193 women diagnosed with placenta accreta spectrum, 122 (63.2%) underwent peripartum total abdominal hysterectomy. Logistic regression analysis was used to compare the outcomes between groups. The study found that a reduced placental volume in the upper uterine segment and an increased volume in the lower uterine segment were significantly associated with a higher likelihood of requiring peripartum hysterectomy (cut-off values of ≤343.4 cm3 and ≥403.4 cm3, respectively; odds ratios of 0.993 [95% CI: 0.990–0.995] and 1.007 [95% CI: 1.005–1.009]).
Additionally, a shortened cervical canal length and increased canal dilatation were linked to an elevated risk of hysterectomy (cut-off values of ≤34 mm and ≥11 mm, respectively; odds ratios of 0.82 [95% CI: 0.77–0.88] and 1.7 [95% CI: 1.4–2.1]). Neonates born before 34 weeks gestation had a 32-fold increased risk of death compared to those born at or after 34 weeks (95% CI: 4.2–250, p = 0.001). These findings suggest that placental MRI is a valuable tool for predicting peripartum hysterectomy and neonatal mortality in patients with total placenta previa, particularly when associated with the placenta accreta spectrum.
Source: sciencedirect.com/science/article/pii/S0301211524004561
