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Carauleanu A, Solomon-Condriuc I, Vicoveanu P, Socolov D, Scripcariu IS, Vasilache IA, Munteanu IV, Baean LM, Adam AM, Mogos R, Gheorghe L. Risks and Probabilities of Adverse Pregnancy Outcomes in Patients Undergoing Trial of Labor after Cesarean-A Retrospective Study. Diagnostics (Basel) 2024; 14:1715. [PMID: 39202203 PMCID: PMC11353003 DOI: 10.3390/diagnostics14161715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/23/2024] [Accepted: 08/05/2024] [Indexed: 09/03/2024] Open
Abstract
(1) Background: Trial of labor after cesarean (TOLAC) can be associated with significant maternal and neonatal complications, and the aim of this retrospective study was to calculate the risks and probabilities of these complications in two tertiary maternity centers in Romania. (2) Methods: A total of 216 patients who attempted TOLAC were included in the study and were segregated into two groups, depending on TOLAC success. Medical records were assessed, and clinical data were used to determine the maternal and neonatal risks and complications, using multinomial logistic regression and postestimation predictions. (3) Results: Our data indicated that patients who had a failed TOLAC had significantly higher risks and probabilities of uterine rupture, either complete or incomplete; intensive care unit (ICU) admission; and emergency hysterectomy. The newborns of these mothers had significantly higher risks and probabilities of low Apgar score at birth, neonatal intensive care unit (NICU) admission, and invasive ventilation. (4) Conclusions: Failed TOLAC could lead to significant maternal and neonatal complications, and women who attempt this procedure should be monitored in a tertiary center where a multidisciplinary team and an emergency operating room are available.
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Affiliation(s)
- Alexandru Carauleanu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Iustina Solomon-Condriuc
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Petronela Vicoveanu
- Department of Mother and Newborn Care, Faculty of Medicine and Biological Sciences, ‘Ștefan cel Mare’ University, 720229 Suceava, Romania
| | - Demetra Socolov
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Ioana-Sadiye Scripcariu
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Ingrid-Andrada Vasilache
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Iulian-Valentin Munteanu
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (I.-V.M.), (A.-M.A.)
| | - Luiza-Maria Baean
- Surgical Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.-M.B.); (L.G.)
| | - Ana-Maria Adam
- Clinical and Surgical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800216 Galati, Romania; (I.-V.M.), (A.-M.A.)
| | - Raluca Mogos
- Department of Mother and Child Care, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (A.C.); (D.S.); (I.-S.S.); (I.-A.V.); (R.M.)
| | - Liliana Gheorghe
- Surgical Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (L.-M.B.); (L.G.)
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Hessami K, Horgan R, Munoz JL, Norooznezhad AH, Nassr AA, Fox KA, Di Mascio D, Caldwell M, Catania V, D'Antonio F, Abuhamad AZ. Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:723-730. [PMID: 38324675 DOI: 10.1002/uog.27606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second- and third-trimester ultrasound examination in pregnancies at risk for PAS. METHODS PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case-control or cross-sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios. RESULTS A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta-analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78-92%) and specificity of 63% (95% CI, 55-70%) during the first trimester, and a sensitivity of 88% (95% CI, 84-91%) and specificity of 92% (95% CI, 85-96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19-100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96-100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72-86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97-100%)). CONCLUSIONS First-trimester ultrasound examination has similar accuracy to second- and third-trimester ultrasound examinations for the diagnosis of PAS. Routine first-trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- K Hessami
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - R Horgan
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J L Munoz
- Division of Fetal Therapy and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - A H Norooznezhad
- Medical Biology Research Centre, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - A A Nassr
- Division of Fetal Therapy and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - K A Fox
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX, USA
| | - D Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - M Caldwell
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - V Catania
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - F D'Antonio
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - A Z Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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Vahdani FG, Shabani A, Haddadi M, Ghalandarpoor-Attar SM, Panahi Z, Hantoushzadeh S, Borna S, Deldar M, Ghashghaee S, Shariat M. Prediction of bleeding in placenta accrete spectrum with lacunar surface: a novel aspect. J Ultrasound 2024; 27:375-382. [PMID: 38551780 PMCID: PMC11178688 DOI: 10.1007/s40477-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/08/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE Diagnosing the placenta accreta spectrum is crucial to prevent morbidities and mortalities among women with the suspicion of this pathology. We aim to evaluate novel ultrasonography markers for these patients in diagnosing and predicting prognosis. METHODS This cross-sectional study was performed in a referral academic hospital. The population was composed of 51 pregnant women with a suspect of placenta accreta spectrum who had scheduled C-sections. Their primary information and past medical histories were documented. Then the ultrasonography markers, including the most bulging volume behind the bladder (area, perimeter, and volume), the Lacune (diameter, length, number, and surface of the largest lacuna obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jellyfish sign, and sponge cervix were evaluated. Their comparison to the severity of the bleeding, the rate of the hysterectomy, and the following pathology of the placenta accreta spectrum were analyzed. RESULTS The results showed that 17 (33.3%) of patients had severe bleeding (more than 2500 cc). The diameter, length, and surface of the largest lacunae limited to women with severe bleeding were 13.50 (5.5-21) mm, 20.50 (11-56) mm, 273.00 (60-1176) mm2, and they were 11.00 (5-24) mm, 16.25 (10-39) mm, and 176.25 (50-744) mm2 for women without severe bleeding (P value = 0.039, 0.027, 0.021). 13 (76.5%) women with severe bleeding had Jellyfish signs,16 (94.2%) had bulging on the cervix, and 10(58.8%) had a sponge cervix (P value = 0.046, 0.036, 0.006). Also, 34 (66.66%) patients needed hysterectomy. The diameter, length, and surface of the largest lacunae limited to women with hysterectomy were 12.00 (5-24) mm, 18.00 (11-56) mm, 231.00 (60-1176) mm2, and they were 9.00 (5-18) mm, 15.00 (10-28) mm, and 136.00(50-504) mm2 for women without hysterectomy (P value = 0.012, 0.070, 0.021). 24(70.6%) women with hysterectomy had Jellyfish signs, 29 (85.3%) of them had bulging on the cervix, and 15 (44.1%) had sponge cervix (P value = 0.05, 0.036, 0.028). The cut-off associated with the Lacunar surface was 163.5 mm2. Its sensitivity was 80%, and its specificity was 48% (P value = 0.021). CONCLUSION The presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accreta spectrum; Moreover, there are some other US criteria, including the presence of a sponge cervix or the Jellyfish sign that are valuable predictive factors for negative outcomes for this spectrum, including hysterectomy.
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Affiliation(s)
- Fahimeh Ghotbizadeh Vahdani
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Azadeh Shabani
- Preventative Gynecology Research Center (PGRC), OBGYN Department, Shahid Beheshti University of Medical Science, Tehran, Iran.
- Taleghani Educational Hospital, Tabnak St. Velenjak Region, Chamran High Way, Tehran, Iran.
| | - Mohammad Haddadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | | | - Zahra Panahi
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sedigheh Borna
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Deldar
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sanaz Ghashghaee
- Department of Obstetrics and Gynecology, Vali-E-Asr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mamak Shariat
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Do QN, Herrera CL, Rosenthal EA, Xi Y, Uddin N, Lewis MA, Fei B, Spong CY, Twickler DM. Magnetic resonance imaging improves diagnosis of placenta accreta spectrum requiring hysterectomy compared to ultrasound. Am J Obstet Gynecol MFM 2024; 6:101280. [PMID: 38216054 PMCID: PMC11070455 DOI: 10.1016/j.ajogmf.2024.101280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Magnetic resonance imaging has been used increasingly as an adjunct for ultrasound imaging for placenta accreta spectrum assessment and preoperative surgical planning, but its value has not been established yet. The ultrasound-based placenta accreta index is a well-validated standardized approach for placenta accreta spectrum evaluation. Placenta accreta spectrum-magnetic resonance imaging markers have been outlined in a joint guideline from the Society of Abdominal Radiology and the European Society of Urogenital Radiology. OBJECTIVE This study aimed to compare placenta accreta spectrum-magnetic resonance imaging parameters with the ultrasound-based placenta accreta index in pregnancies at high risk for placenta accreta spectrum and to assess the additional diagnostic value of magnetic resonance imaging for placenta accreta spectrum that requires a cesarean hysterectomy. STUDY DESIGN This was a single-center, retrospective study of pregnant patients who underwent magnetic resonance imaging, in addition to ultrasonography, because of suspected placenta accreta spectrum. The ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging parameters were obtained. Student's t test and Fisher's exact test were used to compare the groups in terms of the primary outcome (hysterectomy vs no hysterectomy). The diagnostic performance of magnetic resonance imaging and the ultrasound-based placenta accreta index was assessed using multivariable logistic regressions, receiver operating characteristics curves, the DeLong test, McNemar test, and the relative predictive value test. RESULTS A total of 82 patients were included in the study, 41 of whom required a hysterectomy. All patients who underwent a hysterectomy met the International Federation of Gynecology and Obstetrics clinical evidence of placenta accreta spectrum at the time of delivery. Multiple parameters of the ultrasound-based placenta accreta index and placenta accreta spectrum-magnetic resonance imaging were able to predict hysterectomy, and the parameter of greatest dimension of invasion by magnetic resonance imaging was the best quantitative predictor. At 96% sensitivity for hysterectomy, the cutoff values were 3.5 for the ultrasound-based placenta accreta index and 2.5 cm for the greatest dimension of invasion by magnetic resonance imaging. Using this sensitivity, the parameter of greatest dimension of invasion measured by magnetic resonance imaging had higher specificity (P=.0016) and a higher positive predictive value (P=.0018) than the ultrasound-based placenta accreta index, indicating an improved diagnostic threshold. CONCLUSION In a suspected high-risk group for placenta accreta spectrum, magnetic resonance imaging identified more patients who will not need a hysterectomy than when using the ultrasound-based placenta accrete index only. Magnetic resonance imaging has the potential to aid patient counseling, surgical planning, and delivery timing, including preterm delivery decisions for patients with placenta accreta spectrum requiring hysterectomy.
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Affiliation(s)
- Quyen N Do
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Christina L Herrera
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Elise A Rosenthal
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Yin Xi
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Naseem Uddin
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX (Dr Uddin)
| | - Matthew A Lewis
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler)
| | - Baowei Fei
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler); Department of Bioengineering, The University of Texas at Dallas, Richardson, TX (Dr Fei); Center for Imaging and Surgical Innovation, The University of Texas at Dallas, TX (Dr Fei)
| | - Catherine Y Spong
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler)
| | - Diane M Twickler
- Research Division, Department of Radiology, University of Texas (UT) Southwestern Medical Center, Dallas, TX (Drs Do, Xi, Lewis, Fei, and Twickler); Parkland Health and Hospital System, Dallas, TX (Drs Herrera, Rosenthal, Spong, and Twickler).
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Liu Q, Zhou W, Yan Z, Li D, Lou T, Yuan Y, Rong P, Feng Z. Development and validation of MRI-based scoring models for predicting placental invasiveness in high-risk women for placenta accreta spectrum. Eur Radiol 2024; 34:957-969. [PMID: 37589907 DOI: 10.1007/s00330-023-10058-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/12/2023] [Accepted: 06/26/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES To develop and validate MRI-based scoring models for predicting placenta accreta spectrum (PAS) invasiveness. MATERIALS AND METHODS This retrospective study comprised a derivation cohort and a validation cohort. The derivation cohort came from a systematic review of published studies evaluating the diagnostic performance of MRI signs for PAS and/or placenta percreta in high-risk women. The significant signs were identified and used to develop prediction models for PAS and placenta percreta. Between 2016 and 2021, consecutive high-risk pregnant women for PAS who underwent placental MRI constituted the validation cohort. Two radiologists independently evaluated the MRI signs. The reference standard was intraoperative and pathologic findings. The predictive ability of MRI-based models was evaluated using the area under the curve (AUC). RESULTS The derivation cohort included 26 studies involving 2568 women and the validation cohort consisted of 294 women with PAS diagnosed in 258 women (88%). Quantitative meta-analysis revealed that T2-dark bands, placental/uterine bulge, loss of T2 hypointense interface, bladder wall interruption, placental heterogeneity, and abnormal intraplacental vascularity were associated with both PAS and placenta percreta, and myometrial thinning and focal exophytic mass were exclusively associated with PAS. The PAS model was validated with an AUC of 0.90 (95% CI: 0.86, 0.93) for predicting PAS and 0.85 (95% CI: 0.79, 0.90) for adverse peripartum outcome; the placenta percreta model showed an AUC of 0.92 (95% CI: 0.86, 0.98) for predicting placenta percreta. CONCLUSION MRI-based scoring models established based on quantitative meta-analysis can accurately predict PAS, placenta percreta, and adverse peripartum outcome. CLINICAL RELEVANCE STATEMENT These proposed MRI-based scoring models could help accurately predict PAS invasiveness and provide evidence-based risk stratification in the management of high-risk pregnant women for PAS. KEY POINTS • Accurately identifying placenta accreta spectrum (PAS) and assessing its invasiveness depending solely on individual MRI signs remained challenging. • MRI-based scoring models, established through quantitative meta-analysis of multiple MRI signs, offered the potential to predict PAS invasiveness in high-risk pregnant women. • These MRI-based models allowed for evidence-based risk stratification in the management of pregnancies suspected of having PAS.
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Affiliation(s)
- Qianyun Liu
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Wenming Zhou
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Zhimin Yan
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Da Li
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Tuo Lou
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China
| | - Yishu Yuan
- Department of Pathology, The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Pengfei Rong
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Zhichao Feng
- Department of Radiology, The Third Xiangya Hospital of Central South University, No. 138 Tongzipo Road, Changsha, 410013, Hunan, China.
- Department of Medical Imaging, Yueyang Central Hospital, Yueyang, Hunan, China.
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Bonito G, Masselli G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part I: Obstetric (Non-Fetal) Complications. Diagnostics (Basel) 2023; 13:2890. [PMID: 37761257 PMCID: PMC10528445 DOI: 10.3390/diagnostics13182890] [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: 07/30/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Acute abdominopelvic pain in pregnant and postpartum patients presents clinical and therapeutic challenges, often requiring quick and accurate imaging diagnosis. Ultrasound remains the primary imaging investigation. Magnetic resonance imaging (MRI) has been shown to be a powerful diagnostic tool in the setting of acute abdominal pain during pregnancy and puerperium. MRI overcomes some drawbacks of US, avoiding the ionizing radiation exposure of a computed tomography (CT) scan. Although CT is not usually appropriate in pregnant patients, it is crucial in the emergency evaluation of postpartum complications. The aim of this article is to provide radiologists with a thorough familiarity with the common and uncommon pregnancy and puerperium abdominal emergencies by illustrating their imaging appearances. The present first section will review and discuss the imaging findings for acute abdominopelvic pain of obstetric (non-fetal) etiology.
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Affiliation(s)
- Giacomo Bonito
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Gabriele Masselli
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.B.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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