MRI Signs Associated With Bladder Injury During Cesarean Delivery in Severe Placenta Accreta Spectrum Disorders

Area of Science:

• Radiology
• Obstetrics & Gynecology
• Surgical Complications

Background:

• Bladder injury is a significant risk during cesarean delivery (CD) for women with severe placenta accreta spectrum (PAS).
• Injury often occurs during dissection of the vesico-uterine space.
• Placental MRI can help assess preoperative risk for bladder injury.

Purpose of the Study:

• To identify specific MRI signs indicative of high risk for bladder injury during CD in severe PAS cases.
• To improve preoperative risk stratification for bladder injury in this high-risk obstetric population.

Main Methods:

• Retrospective analysis of 167 women with surgically confirmed severe PAS (increta or percreta) undergoing planned CD.
• Evaluation of placental MRI scans (1.5 Tesla) for specific vesico-uterine region features by three experienced radiologists.
• Statistical analysis including univariable and multivariable regression to identify independent predictors of bladder injury.

Main Results:

• 19.8% of women experienced bladder injury during CD.
• Significant associations found between bladder injury and MRI findings: vesico-uterine space hypervascularity (69.7%), absent chemical shift line (57.6%), and uterine-placental bulge (78.8%).
• Vesico-uterine space hypervascularity, absent chemical shift line, and uterine-placental bulge were independently associated with increased risk of bladder injury.

Conclusions:

• Specific MRI features, including vesico-uterine space hypervascularity, absent chemical shift line, and uterine-placental bulge, are linked to bladder injury during CD in severe PAS.
• These MRI signs can serve as effective tools for prenatal assessment, helping to minimize severe complications like hemorrhage and infection.
• This study expands the utility of MRI in managing severe placenta accreta spectrum disorders.