Comparison of the predictive efficacy of ultrasound signs, MRI multi-sequences, and serum AFP in the grading of placental implantation and pregnancy outcomes

BAO Tianping; SHI Defeng; ZHOU Weina; WU Xiangling

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Journal of Hunan Normal University(Medical Science) ›› 2025, Vol. 22 ›› Issue (1) : 48-54.

Comparison of the predictive efficacy of ultrasound signs, MRI multi-sequences, and serum AFP in the grading of placental implantation and pregnancy outcomes

BAO Tianping¹, SHI Defeng², ZHOU Weina¹, WU Xiangling¹

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Abstract

Objective To analyze and compare the predictive value of ultrasound signs, magnetic resonance imaging (MRI) multi-sequences, and serum alpha-fetoprotein (AFP) in the grading of placental implantation and adverse pregnancy outcomes, and to provide a reference for clinical evaluation of placental implantation. Methods A total of 192 pregnant women who underwent cesarean section for placenta implantation in our hospital from March 2021 to January 2023 were selected. According to the pathological results after delivery, they were classified into grade I (83 cases), grade II (78 cases), and grade III (31 cases). and the occurrence of adverse pregnancy outcomes (intraoperative bleeding≥1 500 mL and/or hysterectomy) was counted. All patients underwent ultrasound, MRI, and serum AFP examinations before delivery. The combined predictive value of the last ultrasound sign, MRI multi-sequence, serum AFP, and their combination for placental implantation were analyzed. Results Of the 192 cases, 79 had adverse pregnancy outcomes and 113 had good pregnancy outcomes. The proportion of ultrasound signs and MRI multiple sequence signs of placenta implantation in grade Ⅰ, Ⅱ and Ⅲ groups had statistical significance. The level of serum AFP in grade Ⅲ group was higher than that in grade Ⅱ and Ⅰ groups, and grade Ⅱ group was higher than that in grade Ⅰ group. There were significant differences in the proportion of ultrasound signs and MRI multiple sequence signs between the adverse pregnancy outcome group and the good pregnancy outcome group. Comparison of serum AFP levels was higher in the poor pregnancy outcome group than in the good pregnancy outcome group. The receiver operating characteristic (ROC) curve showed that the AUC of MRI multi-sequence combined with serum AFP for predicting placental implantation grading and adverse pregnancy outcomes were 0.949 (95%CI: 0.907-0.975) and 0.939 (95%CI: 0.895-0.969), respectively, with better predictive performance than ultrasound signs combined with serum AFP. Conclusion The combination of MRI multi-sequence and serum AFP has high application value in the grading of placental implantation and the prediction of adverse pregnancy outcomes, and its predictive efficacy is superior to that of ultrasound signs combined with serum AFP.

Key words

placental implantation / ultrasound / magnetic resonance imaging / alpha-fetoprotein / pregnancy outcome / receiver operating characteristic curve

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BAO Tianping, SHI Defeng, ZHOU Weina, WU Xiangling. Comparison of the predictive efficacy of ultrasound signs, MRI multi-sequences, and serum AFP in the grading of placental implantation and pregnancy outcomes[J]. Journal of Hunan Normal University(Medical Science). 2025, 22(1): 48-54

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