Utility of the angle between the cervical canal and the anatomical conjugate line for predicting pouch of Douglas obliteration in patients with posterior placenta previa

Pouch of Douglas obliteration, which prevents exteriorization of the uterus, increases surgical morbidity in patients with placenta previa. We aimed to identify magnetic resonance imaging features that can predict pouch of Douglas obliteration preoperatively. We retrospectively assessed 39 women wit...

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Bibliographic Details
Published in:PloS one 2023-08, Vol.18 (8), p.e0290244-e0290244
Main Authors: Shinohara, Satoshi, Kasai, Mayuko, Yasuda, Genki, Sunami, Rei
Format: Article
Language:English
Subjects:
Biology and Life Sciences
Canals (anatomy)
Cervix
Cesarean section
Conjugates
Diagnosis
Endometriosis
Gestational age
Glucose
Government agencies
Health aspects
Hospitals
Inclination angle
Magnetic resonance
Magnetic resonance imaging
Mann-Whitney U test
Medical research
Medicine and Health Sciences
Medicine, Experimental
Morbidity
Patients
Placenta
Placenta praevia
Pregnancy
Pregnancy complications
Pregnant women
Research and Analysis Methods
Risk factors
Ultrasonic imaging
Uterus
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Summary:Pouch of Douglas obliteration, which prevents exteriorization of the uterus, increases surgical morbidity in patients with placenta previa. We aimed to identify magnetic resonance imaging features that can predict pouch of Douglas obliteration preoperatively. We retrospectively assessed 39 women with posterior placenta previa who underwent magnetic resonance imaging for the preoperative assessment of placenta accreta spectrum. We defined the angle formed by the anatomical conjugate line (based on pelvimetry) and the cervical canal as the cervical inclination angle, which was measured on sagittal T2-weighted magnetic resonance imaging. Subsequently, we analyzed the correlation between the cervical inclination angle and pouch of Douglas obliteration. The median maternal age was 34 years (range, 22-44 years) and 26 (66.7%) women delivered at term. The median cervical inclination angle was 98° (range, 71-128). Pouch of Douglas obliteration was confirmed in six patients (15.4%). The cut-off value of the cervical inclination angle for the prediction of pouch of Douglas obliteration was 102° with a sensitivity of 66.7%, specificity of 78.8%, positive predictive value of 36.4%, and negative predictive value of 92.9% (area under the curve, 0.83). Measuring the cervical inclination angle may help in ruling out an obliteration of the pouch of Douglas. It may also be useful in the operative management of women with posterior placenta previa. However, caution should be exercised when generalizing the results of this study because of the small sample size, which makes the results prone to bias.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0290244