Abstract
Objective
To construct a scoring model based on MRI signs to predict massive hemorrhage during dilatation and curettage in cesarean scar pregnancy (CSP) patients.
Materials and methods
The MRIs of CSP patients admitted to a tertiary referral hospital between February 2020 and July 2022 were retrospectively reviewed. The included patients were randomly assigned to the training and validation cohorts. The univariate and multivariate logistic regression analyses were adopted to identify the independent risk factors for massive hemorrhage (the amount of bleeding ≥ 200 ml) during the dilatation and curettage. A scoring model predicting intraoperative massive hemorrhage was established where each positive independent risk factor was assigned 1 point, and the predictive power of this model was evaluated both in the training and validation cohorts via the receiver operating characteristic curve.
Results
A total of 187 CSP patients were enrolled, who were divided into the training cohort (31 in 131 patients had massive hemorrhage) and validation cohort (10 in 56 patients had massive hemorrhage). The independent risk factors for intraoperative massive hemorrhage included cesarean section diverticulum area (OR = 6.957, 95% CI 1.993–21.887; P = 0.001), uterine scar thickness (OR = 5.113, 95% CI 2.086–23.829; P = 0.025) and gestational sac diameter (OR = 3.853, 95% CI 1.103–13.530; P = 0.025). A scoring model with a total point of 3 was developed and the CSP patients were divided into low-risk (Total points < 2) and high-risk groups (Total points ≥ 2) for intraoperative massive hemorrhage accordingly. This model possessed high prediction performance both in the training cohort (area under the curve [AUC] = 0.896, 95% CI 0.830–0.942) and validation cohort (AUC = 0.915, 95% CI 0.785–1.000).
Conclusion
We first constructed a MRI-based scoring model for predicting intraoperative massive hemorrhage in CSP patients, which could help the decision-making of the patients’ therapy strategies. Low-risk patients can be cured by D&C alone to reduce the financial burden, while high-risk patients require more adequate preoperative preparation or consideration of changing surgical approaches to reduce bleeding risk.
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Abbreviations
- CSP:
-
Cesarean scar pregnancy
- D&C:
-
Dilatation and curettage
- MRI:
-
Magnetic resonance imaging
- β-hCG:
-
β-Human chorionic gonatropin
- TR:
-
Repetition time
- TE:
-
Echo time
- FOV:
-
Field of view
- CSD:
-
Cesarean section diverticulum
- ICC:
-
Interclass correlation coefficient
- ROC:
-
Receiver operating characteristic curve
- AUC:
-
Area under the curve
- CI:
-
Confidence interval
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Acknowledgements
The authors want to thank the Chengdu Municipal Health Commission for the financial support. The authors would like to dedicate the paper as a memorial for the wedding of Dr. Fengleng Yang and Miss Fanyu Lin on 18 June 2023.
Funding
This study has received funding by the Chengdu Medical Research Projects (Grant No. 2021030).
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FLY and ZGW participated in the conception/design. HBJ and XDW participated in the provision of study material or patients. YZS, XDW, and CD participated in the collection and/or assembly of data. FLY and YZS participated in the data analysis and interpretation. FLY and XLY participated in the manuscript writing. HL and ZGW participated in the manuscript revision. All authors contributed to final approval of manuscript.
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This study was approved by the medical ethics committee of Chengdu women’s and children’s Central Hospital [Approval number: 2021 (107)], and the written informed consent of the research subjects was also obtained.
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Yang, F., Yang, X., Jing, H. et al. MRI-based scoring model to predict massive hemorrhage during dilatation and curettage in patients with cesarean scar pregnancy. Abdom Radiol 48, 3195–3206 (2023). https://doi.org/10.1007/s00261-023-03968-0
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DOI: https://doi.org/10.1007/s00261-023-03968-0