Prediction of antenatal bleeding and preterm deliveries using placental magnetic resonance imaging in patients with placenta previa

Yuko Otake; Atsushi Ugajin; Hironori Takahashi; Yuya Tanaka; Hiroyuki Fujii; Mitsuru Matsuki; Harushi Mori

doi:10.1007/s11604-024-01541-3

Prediction of antenatal bleeding and preterm deliveries using placental magnetic resonance imaging in patients with placenta previa

Jpn J Radiol. 2024 Feb 19. doi: 10.1007/s11604-024-01541-3. Online ahead of print.

Authors

Yuko Otake¹, Atsushi Ugajin², Hironori Takahashi³, Yuya Tanaka⁴, Hiroyuki Fujii⁵, Mitsuru Matsuki⁵, Harushi Mori⁵

Affiliations

¹ Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. oh_yuko@jichi.ac.jp.
² Department of Radiology, National Hospital Organization Tochigi Medical Center, 1-10-37 Naka-Tomatsuri, Utsunomiya, Tochigi, 320-8550, Japan.
³ Department of Obstetrics and Gynecology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
⁴ Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8654, Japan.
⁵ Department of Radiology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.

PMID: 38369566
DOI: 10.1007/s11604-024-01541-3

Abstract

Purpose: This study aimed to clarify associations between subacute hematoma on placental magnetic resonance imaging (MRI), antenatal bleeding, and preterm deliveries in patients with placenta previa (PP) without placenta accreta spectrum (PAS).

Materials and methods: This retrospective study investigated 78 consecutive patients with PP (median age, 34.5 years; interquartile range [IQR], 31-37 years) who underwent placental MRI in the third trimester. Patients with PAS detected intraoperatively or pathologically were excluded. Two radiologists evaluated the presence of subacute hematomas and their locations on placental MRI. We examined associations between presence of subacute hematoma and antenatal bleeding, emergency cesarean section (CS), hysterectomy, gestational age (GA) at delivery, birth weight, and amount of blood loss at CS. We also examined the association between perinatal outcome and subacute hematoma location: marginal, retro-placental, or intra-placental. Inter-observer agreement for the detection of subacute hematoma was calculated using kappa analysis.

Results: Subacute hematomas were identified on MRI in 39 of the 78 patients (50.0%). Antenatal bleeding and emergency CS were more prevalent in patients with subacute hematoma on MRI (20 patients [51.3%] and 18 patients [46.2%], respectively) than in patients without (7 patients [17.9%], Fisher's exact test, p = 0.004 and 7 patients [17.9%], p = 0.014, respectively). GA at delivery was significantly lower in patients with subacute hematoma (median 36w3d, IQR 35w4d-37w1d) than in patients without (median 37w1d, IQR 36w4d-37w2d; Mann-Whitney test: p = 0.048). Marginal hematoma was significantly associated with antenatal bleeding and emergency CS. Inter-observer agreement for the presence of subacute hematoma was moderate (κ = 0.573).

Conclusion: Subacute hematoma on placental MRI was associated with antenatal bleeding, emergency CS and shorter GA at delivery in patients with PP. Marginal hematoma was also associated with antenatal bleeding and emergency CS. Placental MRI appears useful for predicting antenatal bleeding and preterm delivery in patients with PP.

Keywords: Antenatal bleeding; Hematoma; MRI; Placenta previa; Preterm delivery.