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The maximum length of T2-dark intraplacental bands may help predict intraoperative haemorrhage in pregnant women with placenta accreta spectrum (PAS)

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Abstract

Purpose

To investigate the relationship between the maximum length of T2-dark intraplacental bands (MLTIB) and intraoperative haemorrhage in pregnant women with placenta accreta spectrum (PAS).

Methods

Between February 2018 and February 2021, 86 pregnant women with PAS who delivered in Taizhou Hospital of Zhejiang Province and underwent preoperative magnetic resonance imaging (MRI) examination were retrospectively recruited. The presence of T2-dark intraplacental bands, placental/uterine bulge, loss of retroplacental T2-hypointense line, myometrial thinning, bladder wall interruption, focal exophytic mass, and abnormal vascularization of placental bed were recorded, and the MLTIB was measured. The relative risk ratios of the MRI findings and intraoperative bleeding were measured. Receiver operating characteristic (ROC) analysis was used to evaluate the ability of the MLTIB to help predict intraoperative haemorrhage in pregnant women with PAS.

Results

Of the 86 pregnant women, 32 had intraoperative blood loss ≥ 1000 ml; of these, 18 had intraoperative blood loss ≥ 2000 ml. Abnormal vascularization of placental bed was associated with the highest relative risk ratio for the detection of intraoperative haemorrhage (RR = 10.66), followed by the presence of T2-dark intraplacental bands (RR = 8.02). The optimal cut-off of the MLTIB for predicting intraoperative haemorrhage (≥ 1000 ml) in pregnant women with PAS was 28.95 mm, and the AUC was 0.91 (sensitivity: 84%; specificity: 91%). The optimal cut-off of the MLTIB for predicting massive intraoperative haemorrhage (≥ 2000 ml) was 35.65 mm, and the AUC was 0.94 (sensitivity: 89%; specificity: 85%).

Conclusion

MLTIB was related to intraoperative haemorrhage in pregnant women with PAS. An MLTIB greater than 28.95 mm is an effective predictor of intraoperative haemorrhage. An MLTIB of 35.65 mm or greater strongly suggests the possibility of massive intraoperative haemorrhage.

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Author notes

  1. Xiuli Wu and Rongzhen Zhou have contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen street, Linhai, Zhejiang, China

    Xiuli Wu, Rongzhen Zhou, Minjie Lin, Lihong Li, Wenbin Ji & Ke Zheng

  2. Department of Pathology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China

    Yujing Li

  3. Department of Obstetrics and Gynecology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China

    Weijia Ying

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  1. Xiuli Wu
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All authors were involved in patient management and wrote and/or reviewed the report.

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Correspondence to Ke Zheng.

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The study was undertaken after approval by the Institutional Ethics Committee, and the requirement for informed consent was waived.

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Wu, X., Zhou, R., Lin, M. et al. The maximum length of T2-dark intraplacental bands may help predict intraoperative haemorrhage in pregnant women with placenta accreta spectrum (PAS). Abdom Radiol 47, 3594–3603 (2022). https://doi.org/10.1007/s00261-022-03619-w

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