The MRI Estimations of Cervical Length and Cervical Volume Correlate With Massive Hemorrhage in Patients With Placenta Accreta Spectrum Disorders: A Case-Control Study.

OBJECTIVE

The aim of this study is to evaluate the predictive value of two magnetic resonance imaging (MRI) parameters for massive hemorrhage (MH) in pregnancies with placenta accreta spectrum (PAS) disorders.

METHODS AND MATERIALS: This case-control study included 174 patients who underwent MRI for placental assessment. MRI images were independently reviewed by two experienced radiologists blinded to all clinical data. Three-dimensional (3D) models of the cervix were reconstructed, and cervical volume was measured using 3D Slicer software. Multivariate logistic regression analysis was performed to identify risk factors for MH. The predictive performance of cervical length and cervical volume was compared using the area under the receiver operating characteristic curve (AUC).

RESULTS

Compared to patients without MH, those with MH had neonates with significantly lower birth weight (p < 0.001) and were delivered at an earlier mean gestational age (p < 0.001). The MH group also experienced longer operative times (p < 0.001), greater estimated blood loss (p < 0.001), and significantly higher rates of ICU admission and hysterectomy. In predicting MH, cervical volume demonstrated superior performance to cervical length (AUC: 0.85 vs. 0.81). The predictive accuracy was further enhanced when both parameters were combined (AUC = 0.906).

CONCLUSIONS

Shorter cervical length and smaller cervical volume are associated with an increased risk of MH during cesarean section in pregnancies complicated by PAS. These MRI parameters may serve as useful adjuncts for preoperative risk stratification and hemorrhage prediction.