بررسی دقت MRI و سونوگرافی در تشخیص پلاسنتا آکرتا در زنان مستعد مراجعه کننده به بیمارستانهای زنان سطح شهر تبریز

نوع مقاله : اصیل پژوهشی

نویسندگان

1 دانشیار گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران.

2 متخصص زنان و زایمان، دانشکده پزشکی، دانشگاه علوم پزشکی تبریز، تبریز، ایران.

چکیده

مقدمه: پلاسنتا آکرتا عوارض بسیار خطرناکی برای مادر و نوزاد به همراه دارد. تشخیص به‌موقع این عارضه می­تواند خطرات تهدید‌کننده سلامت مادر و نوزاد را کاهش دهد. با توجه به عدم استفاده از MRI در تشخیص به‌موقع پلاسنتا آکرتا در ایران، مطالعه حاضر با هدف بررسی دقت MRI و سونوگرافی در تشخیص پلاسنتا آکرتا در زنان مستعد مراجعه کننده به بیمارستان­های زنان سطح شهر تبریز انجام شد.
روش‌کار: این مطالعه توصیفی مقطعی در طی سال­های 95-1394 در بیمارستان­های زنان شهر تبریز با مشارکت 38 زن مستعد پلاسنتا آکرتا انجام شد. بیماران پس از معاینه به مرکز تصویربرداری (سونوگرافی و MRI) ارجاع شدند و نتایج تصویربرداری با نتایج پس از سزارین مطابقت داده شدند. تجزیه و تحلیل داده­ها با استفاده از نرم‌افزار آماری SPSS (نسخه 20) و آزمون آماری مک نمار انجام شد. میزان p کمتر از 05/0 معنادار در نظر گرفته شد.
یافته‌ها: در بررسی­های انجام شده توسط MRI تعداد 17 نفر (47/89%) پلاسنتا آکرتا داشتند، در حالی که بر اساس بررسی نتایج سونوگرافی، تعداد 12 نفر (15/63%) پلاسنتا آکرتا داشتند. مقایسه اختصاصیت و حساسیت نشان داد که حساسیت (70%) و اختصاصیت (93%) سونوگرافی به‌طور معناداری نسبت به حساسیت (79%) (048/0=p) و اختصاصیت MRI (100%) (039/0=p) کمتر است.
نتیجه‌گیری: دقت، حساسیت و قدرت پیش‌بینی استفاده از تکنیک MRI در تشخیص به‌موقع این عارضه خطرناک در مقایسه با سونوگرافی بسیار مناسب بوده و می­تواند در زنان مستعد پلاسنتا آکرتا به‌کار برده شود.

کلیدواژه‌ها

عنوان مقاله [English]

Accuracy of MRI and Ultrasound in the diagnosis of placenta accreta in susceptible women referred to Tabriz gynecology hospitals

نویسندگان [English]

  • Fatemeh Abasalizadeh 1
  • Shamsi Abasalizadeh 1
  • Ladan Kalafi 2
1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
2 Gynecologist, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
چکیده [English]

Introduction: Placenta accreta has very dangerous effects for mother and baby; timely diagnosis of this complication can decrease the maternal and neonatal health. Due to the lack of MRI use for timely diagnosis of placenta accreta in Iran, this study was performed with aim to evaluate the accuracy of MRI and ultrasound in the diagnosis of placenta accreta in susceptible women referred to gynecology hospitals in Tabriz.
Methods: This cross-sectional descriptive study was conducted in Tabriz gynecology hospitals during 2015-2016 with the participation of 38 susceptible women to placenta accreta. After examination, the patients were referred to the imaging center (ultrasound and MRI) and the results of imaging were compared with the results of after cesarean. Data were analyzed using SPSS software (version 20) and McNemar test. P< 0.05 was considered statistically significant.
Results: MRI examinations showed that 17 patients (89.47%) had placenta accreta, while ultrasound examination showed that 12 (63.15%) had placenta accreta. Comparison of the specificity and sensitivity showed that Ultrasound sensitivity (70%) and specificity (93%) were significantly lower than MRI sensitivity (79%) (p=0.048) and specificity (100%) (p=0.039).
Conclusion: The accuracy, sensitivity, and predictive power of MRI technique in timely detection of this dangerous complication were very good compared to ultrasound and can be used in women susceptible to placenta accreta.

کلیدواژه‌ها [English]

  • Diagnosis
  • MRI
  • Placenta accreta
  • Prediction

مراجع

  1. Jauniaux E, Collins SL, Jurkovic D, Burton GJ. Accreta placentation: a systematic review of prenatal ultrasound imaging and grading of villous invasiveness. American journal of obstetrics and gynecology. 2016;215(6):712-21.
  2. Fox KA, Shamshirsaz AA, Carusi D, Secord AA, Lee P, Turan OM, et al. Conservative management of morbidly adherent placenta: expert review. American journal of obstetrics and gynecology. 2015;213(6):755-60.
  3. Jauniaux E, Burton GJ. Pathophysiology of Placenta Accreta Spectrum Disorders: A Review of Current Findings. Clinical obstetrics and gynecology. 2018;61(4):743-54.
  4. Palacios-Jaraquemada JM, D’Antonio F, Buca D, Fiorillo A, Larraza P. Systematic review on near miss cases of placenta accreta spectrum disorders: correlation with invasion topography, prenatal imaging, and surgical outcome. The Journal of Maternal-Fetal & Neonatal Medicine. 2019:1-8.
  5. de Marcillac FD, Lecointre L, Guillaume A, Sananes N, Fritz G, Viville B, et al. Maternal morbidity and mortality associated with conservative management for placenta morbidly adherent (accreta) diagnosed during pregnancy. Report of 15 cases and review of literature. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2016;206:e149-e50.
  6. Brennan K. Placental pathology: A review of placenta previa, placental abruption and placenta accreta. Obstetric Anaesthesia. 2019:51.
  7. Wang W, Fan D, Wang J, Wu S, Lu Y, He Y, et al. Association between hypertensive disorders complicating pregnancy and risk of placenta accreta: a meta-analysis and systematic review. Hypertension in pregnancy. 2018;37(3):168-74.
  8. Fakhari S, Bile Jani I, Atashkhouei S, Khanbabayi Gol M, Soliemanzadeh S. Comparing the effect of hypotension treatment due to spinal anesthesia with ephedrine or phenylephrine on arterial blood gases and neonatal Apgar score during cesarean delivery in obese mothers: randomized clinical trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2019;22(10):12-20. doi: 10.22038/ijogi.2019.14185.
  9. Khanbabaei Gol M, Aghamohammadi D. Effect of intravenous infusion of magnesium sulfate on opioid use and hemodynamic status after hysterectomy: double-blind clinical trial. The Iranian Journal of Obstetrics, Gynecology and Infertility. 2019;22(7):32-8. doi: 10.22038/ijogi.2019.13815.
  10. Mallah F, Tasbihi P, Navali N, Azadi A. Urinary incontinence during pregnancy and postpartum incidence, severity and risk factors in Alzahra and Taleqani hospitals in Tabriz, Iran, 2011-2012. International Journal of Women's Health and Reproduction Sciences. 2014;2(3):178-85.
  11. Bastani P, Shoari N, HAJEBRAHIMI S, Mallah F, Azadi A. Comparison of performing and not-performing the prophylactic surgery for urinary incontinence in advanced pelvic organ prolapse. International Journal of Women’s Health and Reproduction Sciences. 2014;5(5):311-5.
  12. Ziyadi S, Bastani P, Homayouni A, Mohammad-Alizadeh-Charandabi S, Mallah F. Probiotics and usage in urinary tract infection. Probiotics prebiotics and synbiotics: Bioactive foods in health promotion Elsevier Inc, London. 2016:827-30.
  13. Mallah F, Nazari F, Navali N, Hajipour B. Comparison of direct visual inspection (DVI) with pap smear in diagnosis of precancerous lesion of cervix. Life Science Journal. 2012;9(4):2556-60.
  14. De Mucio B, Serruya S, Alemán A, Castellano G, Sosa CG. A systematic review and meta‐analysis of cesarean delivery and other uterine surgery as risk factors for placenta accreta. International Journal of Gynecology & Obstetrics. 2019.
  15. Happe S, Wells E, Dashe J, Rac M, McIntire D, Twickler D. Validation of the placenta accreta index to predict morbidly adherent placenta. American Journal of Obstetrics and Gynecology. 2017;216(1).
  16. Familiari A, Liberati M, Lim P, Pagani G, Cali G, Buca D, et al. Diagnostic accuracy of magnetic resonance imaging in detecting the severity of abnormal invasive placenta: a systematic review and meta‐analysis. Acta obstetricia et gynecologica Scandinavica. 2018;97(5):507-20.
  17. Woodward PJ, Kennedy A, Einerson BD. Is There a Role for MRI in the Management of Placenta Accreta Spectrum? Current Obstetrics and Gynecology Reports. 2019:1-7.
  18. Pagani G, Cali G, Acharya G, Trisch IT, Palacios‐Jaraquemada J, Familiari A, et al. Diagnostic accuracy of ultrasound in detecting the severity of abnormally invasive placentation: a systematic review and meta‐analysis. Acta obstetricia et gynecologica Scandinavica. 2018;97(1):25-37.
  19. Rac MW, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. American journal of obstetrics and gynecology. 2015;212(3):343. e1-. e7.
  20. Rahaim N, Whitby E. The MRI features of placental adhesion disorder and their diagnostic significance: systematic review. Clinical radiology. 2015;70(9):917-25.
  21. Familiari A, Liberati M, Lim P, Pagani G, Cali G, Buca D, et al. Diagnostic Accuracy of Magnetic Resonance Imaging in Detecting the Severity of Abnormal Invasive Placenta: A Systematic Review and Meta-Analysis. Obstetric Anesthesia Digest. 2019;39(1):6-7.
  22. Budorick NE, Figueroa R, Vizcarra M, Shin J. Another look at ultrasound and magnetic resonance imaging for diagnosis of placenta accreta. The Journal of Maternal-Fetal & Neonatal Medicine. 2017;30(20):2422-7.
  23. Chu C, Zhao S, Ding M, Liu M, Zhang Y, Bao L, et al. Combining Clinical Characteristics and Specific Magnetic Resonance Imaging Features to Predict Placenta Accreta. Journal of computer assisted tomography. 2019;43(5):775.
  24. Pizzi AD, Mincuzzi E, Tavoletta A, Mastrodicasa D, Narciso R, Celentano C, et al., editors. Prenatal planning of placenta previa: diagnostic accuracy of a MRI-based model for the placental invasion and clinical outcome prediction2019: European Congress of Radiology 2019.
  25. Bourgioti C, Zafeiropoulou K, Fotopoulos S, Nikolaidou ME, Theodora M, Daskalakis G, et al. MRI prognosticators for adverse maternal and neonatal clinical outcome in patients at high risk for placenta accreta spectrum (PAS) disorders. Journal of Magnetic Resonance Imaging. 2019;50(2):602-18.
مجله زنان، مامایی و نازایی ایران
دوره 23، شماره 4
تیر 1399
صفحه 1-7

فایل ها

هم رسانی

ارجاع به این مقاله

آمار