The placenta area in sector 2 and cervical area correlate with massive hemorrhage in patients with placenta accreta spectrum disorders

Background Placenta accreta spectrum (PAS) is an obstetric complication related to severe maternal morbidity and mortality, magnetic resonance imaging (MRI) can predict the bleeding risk and the adverse outcomes of the maternal caesarean section in PAS patients. This study aimed to identify whether the placenta area in sector 2 (S2) and cervical area measured by MRI correlate with massive hemorrhage (MH) in complete placenta previa patients with PAS. Methods One hundred and thirty-eight patients were diagnosed as PAS from January 2016 to December 2023. The patients were divided into two groups according to the estimated blood loss volume: MH group (estimated blood loss > 2000mL) and non-MH group (estimated blood loss ≤ 2000mL). The correlation between placenta area in S2, cervical area and MH were evaluated with multivariate analysis. The evaluation capabilities of indicators were assessed using receiver operating characteristic (ROC) analysis. Results The placenta area in S2 of the MH group was significantly higher than that of the group without MH ( P  < 0.001), on the contrary, cervical area was significantly lower in PAS patients with MH than that of the group without MH ( P  < 0.001). A positive linear was found between placental area and amount of blood loss (r = 0.752), and negative linear were found between cervical area and amount of blood loss (r=-0.671), between cervical area and placenta area (r=-0.559). Combined with placental area in S2 and cervical area, the sensitivity, specificity, and the area under the curve (AUC) for the predictive MH were 89.237%, 91.548%, and 0.910, respectively. Conclusion The placenta area in S2 and cervical area may be used to recognize MH in patients with PAS.