• Comparative prognostic value of ultrasound and MRI diagnostic methods for anomalously invasive placenta

Comparative prognostic value of ultrasound and MRI diagnostic methods for anomalously invasive placenta

HEALTH OF WOMAN. 2018.8(134):65–69; doi 10.15574/HW.2018.134.65

Golyanovsky O. V., Ivankova I. N.
Shupyk National Medical Academy of Postgraduate Education, Kiev
Kyiv Oblast Center for Maternal and Child Health

Obstetric hemorrhage (OH) is one of the leading causes of maternal mortality. Every fifth OH is caused by placenta previa (Sakonbat E., 2008), which is accompanied by a high level of perinatal (22%) and maternal mortality (2–10%). In this context, placental pathology is the main cause of profuse bleeding, leading to the development of hemorrhagic shock with fatal consequences. For many years, extragenital pathology occupied the leading position in the structure of the causes of maternal mortality, but since 2012, unfortunately, massive OH has come to the first place, occurring against the background of anomalously invasive placenta.

Recent studies of both domestic and foreign authors are devoted to the search for modern methods of treatment of obstetric hemorrhage, reducing blood loss, and the possibility of preserving the fertile and menstrual functions of a woman. Considering the prophylactic direction of medicine, it became necessary to search for reliable and safe diagnostic methods in order to prevent possible complications in various pathological conditions.

The objective: to determine the sensitivity, specificity and prognostic value of ultrasound and MRI studies for conducting antenatal diagnosis of AIP in pregnant women with a scar on the uterus and placenta previa.

Materials and methods. Ultrasound and MRI diagnostics of 107 pregnant women with a caesarean section in history and placenta previa. Later, the main group of pregnant women was divided into two subgroups: 57 pregnant women entered the Ia group, who showed signs of abnormally invasive placenta against the background of placenta prevalence (after delivery, the diagnosis was confirmed by ultrasound and MRI) and in group Ib pregnant women with a scar on the uterus, prelying placenta with no signs of true placenta increment (AIP or pl. accretа/ increta/percreta).

Results. The sensitivity of the ultrasound diagnostics method for establishing AIP was 94.7%; specificity – 90.3%; the prognostic significance of a positive result – 94.0%. These results are fully consistent with the data of the world scientific literature, convincingly demonstrates the high prognostic value of the ultrasonic diagnostic method of AIP. In 32 pregnant women (56.14%) of 57, partial placenta accreta was diagnosed by ultrasound and MRI; at 15 – pl. increta and in 10 women – pl. percreta, which myometrium germinated not all over the placenta.

The conformity of the diagnoses of AIP according to MRI data was detected in 52 (91.2%) of 57 pregnant women, the preliminary diagnosis differed in 5 (8.8%) of 57 women. The presence of AIP using both methods was correctly diagnosed in 54 (94.7%).

Conclusion. Prenatal diagnosis of AIP in pregnant women with a scar on the uterus and placenta prevalence can be considered quite satisfactory using two main methods – ultrasound and MRI, which allow accurate diagnosis of true placental increment and depth of invasion of placental tissue and have high sensitivity and specificity. If you suspect AIP, in the case of technical capabilities, it is better to use both methods, especially with ambiguous conclusion of an ultrasound or MRI.

Key words: obstetric hemorrhages, abnormally invasive placenta, ultrasound, MRI.

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