| Background and ObjectiveThe placental implantation abnormality(PIA)is defined as: the uterine decidua reduced or absented, and the physiologic fracture line of the decidual sponge layer disappeared between uterine and placenta,which resulted in one or more of the placenta maternal leaves tightly adhered to the decidual basal layer and myometrium.PIA can be divided into three types: the placenta adhesion,the placenta increta and the placenta through. The placenta adhesion is defined as: the placenta adhered to myometrium, but it did not invade myometrium. The placenta increta is defined as: the placental villi invaded into the myometrium.The placenta through is defined as:the placenta invaded the serosal layer of uterus, and even invaded the surrounding tissues of uterus such as the bladder.The PIA can cause bleeding,uncontrolled hemorrhagic shock.It also can threaten the life of the mother and their babies.Early diagnosis of PIA becomes increasingly important,so doctors can think out the treatment of PIA patients and reduce the mortality of mother and child and improve prognosis. The diagnosis of PIA is still a lack of typical clinical presentation and the characteristic experimental project.It is often difficult to diagnosis PIA before delivery,and it often needs some imaging studies todiagnose.Ultrasound is an important means of checking obstetric diseases.With the fast development of image sequence and image processing methods of MRI technology,MRI becomes another important means to diagnosis obstetric diseases.The diagnostic value of MRI in PIA is worth affirmation. MRI can be used as an important method for placental implantation abnormality.Materials and Methods60 patients suspected as placental implantation abnormality by Ultrasound and performed by prenatal MRI were selected in the first affiliated hospital of zhengzhou university from January of 2013 to December of 2014.Their ages were from 25 to 44 years old.Their average age were 31.2±4.38 years old.Gestation week were between28 and 39 weeks.The average gestation week were 35±2 weeks.Of the 60 patients,4patients were primiparas and 56 patients were multiparas.They ever had cesarean section or induced abortion among the 56 multiparas.The 60 patients were all not uterine malformation.49 placental implantation abnormality patients were conformed in the 60 suspected patients with pathologically.Selecting the MRI examination results of 60 patients and comparing with the description of placenta implantation in surgery and pathological examination. Analyzing their consistency and the diagnostic value of MRI in placental implantation abnormality.Results49 placental implantation abnormality patients were conformed in the 60 suspected patients with pathologically. MRI revealed that there were 48 positive cases,and 12 cases were negative.One positive by intraoperative testimony is not PIA, and two negative cases were proved PIA.That is to say one were misdiagnosed and two were missed diagnosis. Two cases missed diagnosed confirmed were adhesion PIA.The statistical analysis found that the accurate ratio and Kappa values of placental implantation abnormality, adhesive placental implantation abnormality, implanted placental implantation abnormality, penetrative placental implantation abnormalitywere 0.95, 0.84; 0.95, 0.64; 0.92,0.81;0.96, 0.57. Their kappa values were greater than 0.4.Their sensitivity were 0.60;0.97;0.33;0.96.And their specificity were0.98;0.80;1.00;0.91.The accuracy of MRI is higher to diagnosis implanted placental implantation abnormality.The Kappa value, sensitivity and specificity of implanted PIA have statistical significance compared with other types(P<0.05).ConclusionThe diagnostic value of MRI in abnormal placental implantation is worth affirmation.According to the situation of placenta implantation in patients, doctors can choose the appropriate treatment,and it can be used to prevent complications of postpartum mothers and babies such as hemorrhage. |
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