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Risk Stratification Based on Imaging Findings for Pregnancies With Subamniotic or Subchorionic Hematoma on Placental
Kumi Harada1, Yuki Himoto2, Yoshitsugu Chigusa3
1Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Background:
Subamniotic or subchorionic hematoma (SAH/SCH) is associated with diverse pregnancy outcomes. The clinical implications of accompanying oligohydramnios and hemorrhagic amniotic fluid on MRI remain unclear.
Purpose:
To investigate the importance of oligohydramnios and hemorrhagic amniotic fluid on placental MRI for SAH/SCH in risk stratification.
Study Type:
Retrospective.
Population:
Seventy-one singleton pregnancies with SAH/SCH identified on placental MRI performed during the second or third trimesters, from 2016 to 2023.
Field Strength/Sequence:
1.5 T, Fat-saturated T1-weighted gradient echo and half-Fourier-acquired single-shot turbo spin echo sequences.
Assessment:
Cases were classified into three groups: Groups A (oligohydramnios and hemorrhagic amniotic fluid), B (either oligohydramnios or hemorrhagic amniotic fluid), and C (SAH or SCH only). Groups B and C were subclassified as B-1 (oligohydramnios), B-2 (hemorrhagic amniotic fluid), C-1 (detected hematoma on ultrasound before MRI), and C-2 (incidentally detected hematoma on MRI). Unfavorable obstetric outcome (abortion or birth before 34 gestational weeks) and neonatal outcome (duration of neonatal intensive care unit [NICU] stay) were compared.
Statistical Tests:
Fisher's exact test, Kruskal-Wallis test, Mann-Whitney U test, and Kaplan-Meier analysis with Log-rank test. Significance was determined at p < 0.05.
Results:
Unfavorable obstetric outcomes were significantly higher in Group A (11/12, 91.7%) than groups B (6/17, 35.3%) and C (9/42, 21.4%). Significant differences were found among the five subclassified groups, most notably between B-1 and B-2. The median duration of NICU stay was 87, 30.5, 0, 25, and 8 days in Groups A (n = 12), B-1 (n = 5), B-2 (n = 12), C-1 (n = 11), and C-2 (n = 31), respectively. Group A showed the worst neonatal outcomes.
Data Conclusion:
MRI findings of oligohydramnios and/or hemorrhagic amniotic fluid in pregnancies with SAH/SCH are associated with adverse obstetric and neonatal outcomes, supporting risk stratification.
Evidence Level:
4.
Technical Efficacy:
Stage 5.
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