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Cervical Length in Patients at Risk for Placenta Accreta
Author(s) -
Rac Martha W.F.,
McIntire Donald D.,
Wells C. Edward,
Moschos Elysia,
Twickler Diane D.
Publication year - 2017
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.16.05059
Subject(s) - medicine , placenta accreta , placenta previa , obstetrics , cervix , gestational age , retrospective cohort study , placenta , gynecology , pregnancy , fetus , surgery , cancer , genetics , biology
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 = 43 [34%]) and without (n = 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 ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less ( P = .001). However, these findings did not correlate with the degree of invasion ( P = .3), or higher rates of vaginal bleeding and preterm labor ( P = .19) resulting in preterm birth before 36 weeks ( P = .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.