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Do QN, Lewis MA, Herrera CL, Owen D, Spong CY, Fei B, Lenkinski RE, Twickler DM, Xi Y. Magnetic Resonance Imaging-Based Radiomics of Axial and Sagittal Orientation in Pregnant Patients with Suspected Placenta Accreta Spectrum. Acad Radiol 2024:S1076-6332(24)00694-9. [PMID: 39366802 DOI: 10.1016/j.acra.2024.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 10/06/2024]
Abstract
RATIONALE AND OBJECTIVES Placenta accreta spectrum (PAS) is associated with significant morbidity and mortality. Current radiomic analysis of PAS magnetic resonance (MR) images is often performed on a single imaging plane. However, depending on the chosen imaging plane, radiomic features extracted from the same patient may vary due to the differing orientations and anatomical contexts, potentially leading to inconsistent results. In this study, we applied region of interest (ROI)-based radiomic analysis on axial and sagittal MR images in pregnant patients at high risk for PAS. Our objective was to compare MR textural features extracted from these imaging planes and to correlate these findings with surgical outcomes, aiming to enhance the accuracy of PAS diagnosis and treatment planning. MATERIALS AND METHODS This is a retrospective review of MR images of pregnancies with prenatally suspected PAS. Volumetric placental, uterus, and internal os of the cervix regions of interest (ROI) were manually segmented on axial and sagittal MR images for each patient. Radiomic features were extracted following the image biomarker standardization initiative guideline. Agreement in features extracted from axial and sagittal images were assessed using Spearman's rank correlation coefficient. RESULTS Of the 101 pregnant patients that met the study inclusion criteria, 65 underwent cesarean hysterectomy for PAS. 77 percent of the radiomics features had strong Spearman rank correlations (>0.8) between axial and sagittal images, indicating that these imaging planes provide similar radiomics information. The diagnostic performance of features extracted from axial and sagittal planes was quantified under the receiver operating characteristics curve (AUC). We found that axial and sagittal planes have similar performance for the prediction of hysterectomy. Shape elongation, Placental Location within the Uterus (PLU), and heterogeneity features were significant predictors for hysterectomy regardless of the imaging plane. CONCLUSION Our study found that radiomics features extracted from axial and sagittal MR image plane in the same patient have excellent agreement and strong correlation. We identified several features present in both axial and sagittal images that were predictive in detecting PAS-suspected patient who required hysterectomy. These features may represent the underlying placental pathophysiology.
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Affiliation(s)
- Quyen N Do
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.).
| | - Matthew A Lewis
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.)
| | - Christina L Herrera
- Department of Obstetrics & Gynecology, UT Southwestern Medical Center, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.); Parkland Health and Hospital System, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.)
| | - David Owen
- Department of Obstetrics & Gynecology, UT Southwestern Medical Center, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.); Parkland Health and Hospital System, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.)
| | - Catherine Y Spong
- Department of Obstetrics & Gynecology, UT Southwestern Medical Center, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.); Parkland Health and Hospital System, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.)
| | - Baowei Fei
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.); Department of Bioengineering, The University of Texas at Dallas, Richardson, Texas, USA (B.F.); Center for Imaging and Surgical Innovation, The University of Texas at Dallas, Texas, USA (B.F.)
| | - Robert E Lenkinski
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.)
| | - Diane M Twickler
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.); Department of Obstetrics & Gynecology, UT Southwestern Medical Center, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.); Parkland Health and Hospital System, Dallas, Texas, USA (C.L.H., D.O., C.Y.S., D.M.T.)
| | - Yin Xi
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA (Q.N.D., M.A.L., B.F., R.E.L., D.M.T., Y.X.)
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Kyozuka H, Sugeno M, Murata T, Jin T, Ito F, Nomura Y, Hirano T, Shinohara K, Suzuki D, Ishida T. Introduction and utility of resuscitative endovascular balloon occlusion of the aorta for cases with a potential high risk of postpartum hemorrhage: A single tertiary care center experience of two cases. Fukushima J Med Sci 2022; 68:117-122. [PMID: 35444074 PMCID: PMC9493338 DOI: 10.5387/fms.2022-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Postpartum hemorrhage is an important obstetric complication and the leading cause of maternal mortality worldwide. Occasionally, we encounter unexpected massive postpartum hemorrhage diagnosed for the first time after delivery. Therefore, it is essential to pay attention to patients with a high risk of postpartum hemorrhage. The authors report two cases of patients at high risk of postpartum hemorrhage that were successfully managed by resuscitative endovascular balloon occlusion of the aorta before cesarean section. Case 1: A 32-year-old woman with a history of cesarean section and who conceived using assisted reproductive technology was diagnosed with partial placenta previa at 25 weeks of gestation. Because of tocolysis failure, emergent cesarean section with resuscitative endovascular balloon occlusion of the aorta was performed at 36 weeks of gestation. Natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage. Case 2: A 41-year-old woman with suspected placenta accreta spectrum due to a cesarean scar pregnancy was referred to our hospital at 33 weeks of gestation. A planned cesarean section with resuscitative endovascular balloon occlusion of the aorta was conducted at 37 weeks of gestation. There was no visual evidence of abnormal placental invasion of the myometrium, and natural placental resorption was observed. She was discharged at 5 days after delivery without significant hemorrhage.
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Affiliation(s)
- Hyo Kyozuka
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Misa Sugeno
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Tsuyoshi Murata
- Department of Obstetrics and Gynecology, Shirakawa Kosei General Hospital
| | - Toki Jin
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Fumihiro Ito
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Yasuhisa Nomura
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Takaki Hirano
- Department of Emergency and Critical Care, Ohta Nishinouchi Hospital
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care, Ohta Nishinouchi Hospital
| | - Daisuke Suzuki
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital
| | - Tokiya Ishida
- Department of Emergency and Critical Care, Ohta Nishinouchi Hospital
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Bloomfield V, Rogers S, Scattolon S, Morais M, Leyland N. Informing the spectrum of approaches: Institutional review of placenta accreta spectrum disorders management. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:365-371. [PMID: 34740850 DOI: 10.1016/j.jogc.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Placenta accreta spectrum (PAS) is a condition defined by abnormal adherence of the placenta. Cesarean hysterectomy is the preferred management, but practice patterns vary based on local resources and expertise. We retrospectively reviewed the clinical course of patients diagnosed antenatally with PAS who underwent surgical management in our centre. METHODS We conducted a retrospective records review involving patients with an antenatal diagnosis of PAS between 2014 and 2019. The primary outcome was a composite score of maternal morbidity, and secondary outcomes were total estimated blood loss and composite neonatal morbidity. Patients were stratified based on the presence or absence of PAS on final pathology. Antenatal diagnosis by ultrasound and magnetic resonance imaging (MRI) was compared with final histologic diagnosis. RESULTS A total of 34 patients were diagnosed with PAS antenatally and managed at our institution. Final histology confirmed PAS in 29 patients. The overall composite morbidity rate was 44%, with no significant difference between patients with and without PAS on pathology (P = 0.355). Intraoperative blood loss was similar between the 2 groups (2374 ± 2212 mL vs. 1080 ± 852 mL; P = 0.232). The rate of composite neonatal morbidity was 47%. Ultrasound achieved a high positive predictive value in the diagnosis of PAS (96%) and more accurately predicted pathology than MRI. CONCLUSIONS PAS is associated with high rates of morbidity. Dissemination of our local experience serves to inform best practices in the management of this complex condition.
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Affiliation(s)
- Valerie Bloomfield
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Stacey Rogers
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Sarah Scattolon
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Michelle Morais
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8
| | - Nicholas Leyland
- Department of Obstetrics and Gynecology, McMaster University Medical Center, 1280 Main St W, Hamilton, Ontario, Canada, L8S 4L8.
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Zhong W, Zhu F, Li S, Chen J, He F, Xin J, Yang M. Maternal and Neonatal Outcomes After Planned or Emergency Delivery for Placenta Accreta Spectrum: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2021; 8:731412. [PMID: 34650996 PMCID: PMC8505704 DOI: 10.3389/fmed.2021.731412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: To compare maternal and neonatal outcomes for women with placenta accreta syndrome (PAS) delivering via a planned or emergent approach. Methods: A systematic search for relevant studies was conducted by screening the PubMed, Scopus, Web of Science, and Google Scholar electronic databases. Included studies should have been retrospective record-based or prospective in design. They must have compared maternal and/or neonatal outcomes for PAS patients delivering via planned and emergency procedures. Strength of association was presented as pooled adjusted relative risk (RR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. Statistical analysis was done using STATA version 16.0. Results: Nine articles were included in the meta-analysis. PAS patients undergoing planned deliveries had increased gestational ages, required fewer units of transfused blood, experienced shorter hospital stay durations, and presented reduced risks for maternal ICU admission and severe maternal morbidity. Neonates born to mothers undergoing planned deliveries had increased birth weights and decreased NICU admission risk. Conclusion: These findings indicate a planned approach for delivery is better for maternal and neonatal outcomes compared to urgent/emergency delivery for PAS patients.
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Affiliation(s)
- Wei Zhong
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fang Zhu
- Department of Pain, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shengqiong Li
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Chen
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fengya He
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Xin
- Department of Obstetrics, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mei Yang
- Department of Traditional Therapy, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Crosland BA, Sherman-Brown AM, Oakes MC, Cuevas LR, Dinicu AI, Altieri EJ, Hutchison DM, Chang J, Ziogas A, Nageotte MP, Shrivastava VK. Complicated placenta accreta spectrum: identifying a high-risk cohort. J Matern Fetal Neonatal Med 2021; 35:7778-7786. [PMID: 34112053 DOI: 10.1080/14767058.2021.1937108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess differences in the perioperative complication rate between patients with placenta accreta spectrum (PAS) with and without complicating factors. METHODS This retrospective cohort study included subjects who underwent cesarean hysterectomy with histology-proven PAS between 23 0/7 and 42 0/7 weeks gestational age (GA) from 1 July 2008 to 11 April 2017. Perioperative outcomes were compared between those with uncomplicated PAS and "complicated PAS," defined as PAS subjects who experienced ≥2 bleeding episodes, preterm premature rupture of membranes (PPROM), or premature contractions requiring tocolysis. RESULTS Overall, 26 complicated PAS and 27 uncomplicated PAS cases were compared; no difference in the rate of perioperative complications was identified. An increased proportion of complicated PAS cases required blood product transfusion before delivery: 2 (40%), 3 (27.3%), and 2 patients (20%) for those with PPROM, preterm contractions, and ≥2 bleeding episodes respectively, compared to patients with uncomplicated PAS, having no transfusions (p = .001). Time of delivery was earlier for patients with complicated compared to uncomplicated PAS (median GA 30.9 [Q1 = 27.9; Q3 = 31.9] and 34.9 [Q1 = 32.1; Q3 = 35.7], p < .001). Median birthweights were lower (p < .0144) and maternal length of stay longer (p < .0012) for complicated PAS. CONCLUSION Patients with complicated PAS were not at higher risk for perioperative complications but were associated with earlier delivery, required more antenatal blood transfusions, and had a longer LOS.
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Affiliation(s)
- Brian A Crosland
- Department of Obstetrics and Gynecology, University of California - Irvine, Irvine, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Alice M Sherman-Brown
- Department of Obstetrics and Gynecology, University of California - Irvine, Irvine, CA, USA
| | - Megan C Oakes
- Department of Obstetrics and Gynecology, University of California - Irvine, Irvine, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Laura R Cuevas
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Andreea I Dinicu
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Emma J Altieri
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Dana M Hutchison
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Jenny Chang
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Argyrios Ziogas
- School of Medicine, University of California - Irvine, Irvine, CA, USA
| | - Michael P Nageotte
- Department of Obstetrics and Gynecology, University of California - Irvine, Irvine, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA
| | - Vineet K Shrivastava
- Department of Obstetrics and Gynecology, University of California - Irvine, Irvine, CA, USA.,Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Long Beach Memorial Medical Center, Long Beach, CA, USA
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Lin J, Lin F, Zhang Y. Uterine artery ligation before placental delivery during caesarean in patients with placenta previa accreta. Medicine (Baltimore) 2019; 98:e16780. [PMID: 31490365 PMCID: PMC6739010 DOI: 10.1097/md.0000000000016780] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/10/2019] [Accepted: 07/18/2019] [Indexed: 11/26/2022] Open
Abstract
To investigate the influence of uterine artery ligation before placental delivery during cesarean section on postpartum hemorrhage (PPH) and related complications in patients with placenta previa accreta.A retrospective study was conducted of data from 78 patients with pernicious placenta previa, treated at Fujian Provincial Maternal and Child Health Hospital (Fuzhou, China) between January 2014 and June 2018. Twenty-nine patients underwent uterine arterial ligation before placental delivery (UALBPD), and the other 49 patients in the control group did not undergo peri-paracentesis before the delivery of the placenta. The statistical analysis and data management were performed with SPSS 19.0.The intraoperative and postoperative complications after uterine artery ligation were compared between the 2 groups: in the UALBPD group, no woman (0.0%) underwent a subtotal cesarean hysterectomy, whereas four (8.2%) did so in the control group (P = .24). The mean number of packed red blood cell (RBC) units transfused was 3.7 ± 1.2 in the UALBPD group and 5.7 ± 3.4 units in the control group (P = .0002). The estimated blood loss was 734.2 ± 317.5 mL in the UALBPD group and 1101.6 ± 442.7 mL in the control group (P < .0001). Nine (31.0%) women in the UALBPD group underwent transfusion compared with 38 (77.6%) in the control group (P = .003). The reduction in hemoglobin was 2.63 ± 1.85 g/L in the UALBPD group and 5.41 ± 2.38 g/L in the control group (P < .0001). The reduction in hematocrit was 2.96 ± 4.07 in the UALBPD group and 6.77 ± 8.74 (%) in the control group (P = .009).Bilateral uterine artery ligation before the delivery of the placenta in women with placenta accreta can effectively reduce the amount of intraoperative blood loss, the incidence of PPH, and the risk of complications, such as hysterectomy.
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