关键词: 磁共振成像, 超声评分系统, 胎盘植入性疾病, 不良妊娠结局, 预测模型

Abstract: To evaluate the efficiency of ultrasound scoring system combined DOI：10.3760/cma.j.cn441417-20240729-01002 收稿日期 2024-07-29 本文编辑 吴相思 引用本文：李西娜, 窦盼, 李令民. 超声评分系统联合MRI对胎盘植入性疾病患者不良妊娠结局的预测模 型构建[J]. 国际医药卫生导报, 2025, 31(1): 5-11. DOI: 10.3760/cma.j.cn441417-20240729-01002. · 5 · 国际医药卫生导报 2025 年1 月第 31 卷第 1 期　IMHGN, January 2025, Vol. 31, No. 1 with magnetic resonance imaging (MRI) in predicting adverse pregnancy outcomes in patients with placenta accreta spectrum disorders. Methods This study was a cross-sectional study. A total of 180 patients with placenta accreta spectrum disorders who underwent cesarean section in Xi'an People's Hospital (Xi'an Fourth Hospital) from January 2021 to January 2024 were selected as the study objects. The patients were assessed using the placenta accreta ultrasound scoring system established by Peking University Third Hospital, and they received MRI before delivery, including 5 MRI signs. The clinical data of all patients were collected, and the adverse pregnancy outcomes were defined as intraoperative uterine rupture, intraoperative bleeding ≥1 500 ml, hysterectomy, or severe postpartum infection. The patients were divided into a normal outcome group (99 cases) and an adverse outcome group (81 cases). Logistic regression analysis was used to analyze the influencing factors of adverse pregnancy outcomes in patients with placenta accreta spectrum disorders, and a nomogram model was constructed. The receiver operating characteristic curve (ROC), calibration curve, and decision curve were used to evaluate the prediction model. Independent sample t test, rank sum test, and χ2 test were used for statistical analysis. Results The normal outcome group was (33.57±3.82) years old, and the adverse outcome group was (34.56± 3.68) years old, without statistically significant difference (P>0.05). The numbers of pregnancies and births in the adverse outcome group were 4 (3, 5) and 1 (1, 2), respectively, which were higher than 3 (2, 4) and 1 (1, 1) in the normal outcome group; the gestational age at delivery in the adverse outcome group was (35.12±2.54) weeks, which was shorter than that in the normal outcome group [(36.68±2.31) weeks]; the ultrasound score in the adverse outcome group was (11.05±1.15) points, which was higher than that in the normal outcome group [(7.00±1.00) points]; the case numbers of placental intravascular growth signs (lakes), T2 dark bands within the placenta, uterine bulging, cervical invasion, and vascular proliferation at the uterine-bladder interface in the adverse outcome group were 64, 67, 62, 18, and 63, respectively, which were more than 37, 36, 32, 4, and 35 in the normal outcome group, with statistically significant differences (all P<0.05). Univariate and multivariate logistic regression analysis showed that gestational week at delivery was an independent protective factor for adverse pregnancy outcomes in patients with placenta accreta spectrum disorders (OR<1, P<0.05); the numbers of pregnancies and births, ultrasound score, placental intravascular growth signs (lakes), T2 dark bands within the placenta, uterine bulging, cervical invasion, and vascular proliferation at the uterine-bladder interface were independent risk factors for adverse pregnancy outcomes (all OR>1, P<0.05). According to the multivariate logistic regression analysis results, a nomogram model was constructed, and ROC analysis was performed on the nomogram model. The sensitivity of the nomogram model was 97.50%, the specificity was 94.90%, the Youden index was 0.924, and the area under the curve (AUC) was 0.980 (0.961-0.999). Conclusions Ultrasound scoring system combined with MRI can effectively predict adverse pregnancy outcomes in patients with placenta accreta spectrum disorders. By using appropriate scoring and imaging standards, physicians can more accurately identify high-risk patients, thereby taking intervention measures to improve pregnancy outcomes. The high sensitivity and specificity of the nomogram model further confirm the clinical application value of this prediction method, providing an important tool for the management of high-risk pregnancies.

Key words: Magnetic resonance imaging, Ultrasound scoring system, Placenta accreta spectrum disorders, Adverse pregnancy outcomes, Prediction model