Magnetic resonance imaging and previous cesarean section in placenta accrete spectrum disorder: Predictor model

Abstract Objective To evaluate objective criteria of Magnetic Resonance Imaging (MRI) of Placenta Accreta Spectrum disorder (PAS) analyzing interobserver agreement and to derive a model including imaging and clinical variables to predict PAS. Methods A retrospective review including patients submitted to MRI with suspicious findings of PAS on ultrasound. Exclusion criteria were lack of pathology or surgical information and missing or poor-quality MRI. Two radiologists analyzed six MRI features, and significant clinical data were also recorded. PAS confirmed on pathology or during intraoperative findings were considered positive for the primary outcome. Variables were tested through logistic regression models. Results Final study included 96 patients with a mean age of 33 years and 73.0% of previous C-sections. All MRI features were significantly associated with PAS for both readers. After logistic regression fit, including MRI signs with a moderate or higher interobserver agreement, intraplacental T2 dark band was the most significant radiologic criteria, and ROC analysis resulted in an AUC = 0.782. After including the most relevant clinical data (previous C-section) to the model, the ROC analysis improved to an AUC = 0.893. Conclusion Simplified objective criteria on MRI, including intraplacental T2 dark band associated with clinical information of previous C-sections, had the highest accuracy and was used for a predictive model of PAS.

Analise da maturidade fetal no liquido amniotico e sua correlacao com as complicacoes perinatais nas formas graves das sindromes hipertensivas na gravidez / Correlation of fetal maturity analysis in the amniotic fluid and perinatal complications of severe hypertension in pregnancy

O objetivo deste estudo foi analise da maturidade fetal, atraves do estudo do liquido amniotico obtido pela amniocentese, e sua correlacao com as complicacoes neonatais nas formas graves das sindromes hipertensivas na gravidez. Foram estudadas, de forma retrospectiva, 91 amostras de liquido amniotico avaliando-se a maturidade fetal atraves do teste de Clements e contagem de celulas orangiofilas. Considerou-se maduro, quando teste de Clements foi positivo ate o terceiro tubo e/ou celulas orangiofilas maior ou igual a 10 por cento; intermediario, quando teste de Clements foi positivo ate o segundo tubo e contagem de celulas orangiofilas de 6 por cento a 9 por cento e imaturo quando teste de Clements foi positivo ate o primeiro tubo ou negativo e/ou positivo de celulas orangiofilas menor ou igual a 5 por cento...

Transfusao intravascular por cordocentese na terapeutica da doenca hemolitica perinatal / Intravascular intrauterine transfusion by cordocentesis in Rh alloimmunization

Os autores relatam a experiencia com 65 transfusoes intravasculares no tratamento da Doenca Hemolitica Perinatal realizada em 25 gestacoes complicadas por aloimunizacao Rh no periodo de janeiro a dezembro de 1991. As transfusoes comecaram entre 20-34 semanas e foram repetidas ate 6 vezes, com intervalos de 3-28 dias...