The MRI estimations of placental thickness and cervical length correlate with postpartum hemorrhage (PPH) in patients with risk for placenta accreta spectrum (PAS) disorders

Abstract

IntroductionThis study aims to identify whether placental thickness and cervical length measured by MRI correlate with postpartum hemorrhage (PPH) in patients at high risk for placenta accreta spectrum (PAS) disorders. MethodsThe placental thickness and cervical length of 200 patients from October 2017 to October 2021 were retrospectively measured. The mid-sagittal plane of the placentas was measured by 2 independent radiologists using MRI. Partial correlation analysis was used to characterize the correlation between placental thickness, cervical length and estimated blood loss during surgery. The correlation between clinical features, placental thickness, cervical length and PPH was evaluated with univariate and multivariate analyses. A nomogram was constructed based on the logistic regression. ResultsPlacental thickness was positively correlated with the estimated blood loss during delivery, while cervical length had a negative correlation with it, based on the adjustment for gestational age. Multivariate analyses revealed that prior cesarean section, placenta previa, increased placental thickness(≧4.35 cm) and short cervical length（< 3.05 cm） were independent risk factors for PPH. When the 4 risk factors were combined together, the AUC was the highest, 0.773 (95%CI 0.707–0.840). DiscussionPlacental thickness and cervical length correlated with PPH. The nomogram constructed based on prior cesarean section, placenta previa, placental thickness and cervical length can be used to recognize patients with a higher risk of PPH.