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Obstetrics and Gynecology

Cervical Length in Patients at Risk for Placenta Accreta

Profile image of Donald McIntireDonald McIntire

2017, Journal of Ultrasound in Medicine

https://doi.org/10.7863/ULTRA.16.05059
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6 pages

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Abstract

Objectives-To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth. Methods-We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used. Results-A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n 5 43 [34%]) and without (n 5 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32-to 34-week ultrasound examinations (mean 6 SD, 3.23 6 0.98 versus 3.95 6 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P 5 .001). However, these findings did not correlate with the degree of invasion (P 5 .3), or higher rates of vaginal bleeding and preterm labor (P 5 .19) resulting in preterm birth before 36 weeks (P 5 .64). Conclusions-Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks.

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Obstetrics & Gynecology, 2015

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Ruslan Sergienko

American Journal of Obstetrics and Gynecology, 2013

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Placenta Accreta: Five-Year Experience at a Tertiary-Care Center
Varun Malhotra

Objective: The goals of this analysis were (1) to evaluate the demographic profiles, high risk factors, fetomaternal outcomes, and management options for patients with placenta accreta, and (2) to plan future strategies for managing this condition. Materials and Methods: This retrospective analysis involved a review of 17 case records of women with placenta accreta from January 2007 to December 2011. Results: The mean age of the patients was 27.2 -3.8 years, and 7.6% of these women were grandmultiparous. Fourteen women (82.35%) had previous caesarean section scars and 11 women (64.7%) had scarred uteri with placenta previa. Twelve women (70.5%) presented antenatally with antepartum hemorrhage. Fourteen women have operative procedures performed on an emergency basis, and the remaining 3 women were scheduled for elective surgery. Seven of 17 women (41.7%) underwent hysterectomy. The remaining 10 patients (58.82%) were managed conservatively. Bladder injury during dissection occurred in 5 patients (29.4%). Massive blood loss was a prominent feature of this condition, with a mean blood loss of 2.8 L. There was 1 (5.8%) maternal mortality. The average gestational age was 35.4 weeks. Sixty percent of the neonates were preterm, with an average birth weight of 2.1 kg. Perinatal mortality was 35%. Conclusions: Cesarean section and placenta previa are significant risk factors for placenta accreta. This condition is associated with high fetomaternal morbidity and mortality. ( J GYNECOL SURG 30:91)

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