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Vahdani FG, Shabani A, Haddadi M, Ghalandarpoor-Attar SM, Panahi Z, Hantoushzadeh S, Borna S, Deldar M, Ghashghaee S, Shariat M. Prediction of bleeding in placenta accrete spectrum with lacunar surface: a novel aspect. J Ultrasound 2024; 27:375-382. [PMID: 38551780 PMCID: PMC11178688 DOI: 10.1007/s40477-024-00878-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/08/2024] [Indexed: 06/15/2024] Open
Abstract
PURPOSE Diagnosing the placenta accreta spectrum is crucial to prevent morbidities and mortalities among women with the suspicion of this pathology. We aim to evaluate novel ultrasonography markers for these patients in diagnosing and predicting prognosis. METHODS This cross-sectional study was performed in a referral academic hospital. The population was composed of 51 pregnant women with a suspect of placenta accreta spectrum who had scheduled C-sections. Their primary information and past medical histories were documented. Then the ultrasonography markers, including the most bulging volume behind the bladder (area, perimeter, and volume), the Lacune (diameter, length, number, and surface of the largest lacuna obtained by multiplying the length by the width), the most considerable thickness of placenta on the cervix in patients with placenta previa, the most considerable thickness of the placenta behind the bladder, the Jellyfish sign, and sponge cervix were evaluated. Their comparison to the severity of the bleeding, the rate of the hysterectomy, and the following pathology of the placenta accreta spectrum were analyzed. RESULTS The results showed that 17 (33.3%) of patients had severe bleeding (more than 2500 cc). The diameter, length, and surface of the largest lacunae limited to women with severe bleeding were 13.50 (5.5-21) mm, 20.50 (11-56) mm, 273.00 (60-1176) mm2, and they were 11.00 (5-24) mm, 16.25 (10-39) mm, and 176.25 (50-744) mm2 for women without severe bleeding (P value = 0.039, 0.027, 0.021). 13 (76.5%) women with severe bleeding had Jellyfish signs,16 (94.2%) had bulging on the cervix, and 10(58.8%) had a sponge cervix (P value = 0.046, 0.036, 0.006). Also, 34 (66.66%) patients needed hysterectomy. The diameter, length, and surface of the largest lacunae limited to women with hysterectomy were 12.00 (5-24) mm, 18.00 (11-56) mm, 231.00 (60-1176) mm2, and they were 9.00 (5-18) mm, 15.00 (10-28) mm, and 136.00(50-504) mm2 for women without hysterectomy (P value = 0.012, 0.070, 0.021). 24(70.6%) women with hysterectomy had Jellyfish signs, 29 (85.3%) of them had bulging on the cervix, and 15 (44.1%) had sponge cervix (P value = 0.05, 0.036, 0.028). The cut-off associated with the Lacunar surface was 163.5 mm2. Its sensitivity was 80%, and its specificity was 48% (P value = 0.021). CONCLUSION The presence of single large lacunae could be a suitable predictive factor for bleeding in the placenta accreta spectrum; Moreover, there are some other US criteria, including the presence of a sponge cervix or the Jellyfish sign that are valuable predictive factors for negative outcomes for this spectrum, including hysterectomy.
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Affiliation(s)
- Fahimeh Ghotbizadeh Vahdani
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Azadeh Shabani
- Preventative Gynecology Research Center (PGRC), OBGYN Department, Shahid Beheshti University of Medical Science, Tehran, Iran.
- Taleghani Educational Hospital, Tabnak St. Velenjak Region, Chamran High Way, Tehran, Iran.
| | - Mohammad Haddadi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | | | - Zahra Panahi
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sedigheh Hantoushzadeh
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sedigheh Borna
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Maryam Deldar
- Maternal-Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Science, Tehran, Iran
| | - Sanaz Ghashghaee
- Department of Obstetrics and Gynecology, Vali-E-Asr Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Mamak Shariat
- Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Wu X, Yang H, Yu X, Zeng J, Qiao J, Qi H, Xu H. The prenatal diagnostic indicators of placenta accreta spectrum disorders. Heliyon 2023; 9:e16241. [PMID: 37234657 PMCID: PMC10208845 DOI: 10.1016/j.heliyon.2023.e16241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Placenta accreta spectrum (PAS) disorders refers to a heterogeneous group of anomalies distinguished by abnormal adhesion or invasion of chorionic villi through the myometrium and uterine serosa. PAS frequently results in life-threatening complications, including postpartum hemorrhage and hysterotomy. The incidence of PAS has increased recently as a result of rising cesarean section rates. Consequently, prenatal screening for PAS is essential. Despite the need to increase specificity, ultrasound is still considered a primary adjunct. Given the dangers and adverse effects of PAS, it is necessary to identify pertinent markers and validate indicators to improve prenatal diagnosis. This article summarizes the predictors regarding biomarkers, ultrasound indicators, and magnetic resonance imaging (MRI) features. In addition, we discuss the effectiveness of joint diagnosis and the most recent research on PAS. In particular, we focus on (a) posterior placental implantation and (b) accreta after in vitro fertilization-embryo transfer, both of which have low diagnostic rates. At last, we graphically display the prenatal diagnostic indicators and each diagnostic performance.
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Affiliation(s)
- Xiafei Wu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Huan Yang
- Department of Obstetrics, Chongqing University Three Gorges Hospital, Chongqing 404100, China
| | - Xinyang Yu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jing Zeng
- Stomatological Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Juan Qiao
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Women and Children's Hospital of Chongqing Medical University, Chongqing 401147, China
| | - Hongbing Xu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Montero-Yéboles R, Arroyo-Marin MJ, Jaraba-Caballero S, Gómez-Guzman E, Frías-Pérez M, Ruiz-Sáez B, Pérez-Navero JL. A pleural ultrasound image of a collapsed lung surrounded by pleural fluid ("jellyfish sign") may correspond to an intrapericardial mass. J Ultrasound 2021; 25:387-390. [PMID: 33768495 DOI: 10.1007/s40477-021-00577-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
Lung ultrasound has been shown to be a valuable diagnostic tool. It has become the main way to get to the diagnosis of pleural effusion with much more specificity and sensibility than the x-ray. The diagnosis of pleural effusion with ultrasound is easily obtained after the visualization of hypoechoic fluid surrounding the lung. Sometimes it appears as an image of a collapsed lung moving with the surrounded pleural fluid ("jellyfish sign"). Until now this sign was almost pathognomonic of pleural effusion, but we explore a case in which this sign could have led to a misleading diagnosis. We present the case of a child admitted to intensive care with respiratory distress. In the point of care lung ultrasound we believed to see a pleural effusion with a collapsed lung moving into the effusion. Due to the enlargement of the pericardial sac, we did not realize that what we thought to be the pleural space was in fact the pericardial space. Unfortunately, there was a more echogenic area inside the pericardial effusion which led to a misleading fake lung atelectasis with pleural effusion ("jellyfish sign"). The correct diagnosis was properly obtained after assessing a cardiac point of care ultrasound using a four chambers view. The left side of the thorax is more difficult to be sonographed than the right due to the presence of the heart fossa that occupies a significant part of that side. Obtaining the diagnosis of pleural effusion on that side is more difficult for this reason and can sometimes be misleading with a pericardial effusion. The presence of the "jellyfish sign" is not pathognomonic and may lead to an error if we are guided only by the presence of that sign. To avoid such a misleading diagnosis, we highly recommend performing a point of care cardiac ultrasound if a pleural effusion is primarily seen in the lung ultrasound.
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Affiliation(s)
- R Montero-Yéboles
- Pediatric Intensive Care Unit, Department of Pediatrics at Reina, Sofia University Hospital, Córdoba University, Avda.Menéndez Pidal s/n, C.P.14004, Córdoba, Spain.
| | - M J Arroyo-Marin
- Pediatric Cardiology Unit, Department of Pediatrics At Reina, Sofia University Hospital, Córdoba University, Córdoba, Spain
| | - S Jaraba-Caballero
- Pediatric Intensive Care Unit, Department of Pediatrics at Reina, Sofia University Hospital, Córdoba University, Avda.Menéndez Pidal s/n, C.P.14004, Córdoba, Spain
| | - E Gómez-Guzman
- Pediatric Intensive Care Unit, Department of Pediatrics at Reina, Sofia University Hospital, Córdoba University, Avda.Menéndez Pidal s/n, C.P.14004, Córdoba, Spain
| | - M Frías-Pérez
- Pediatric Intensive Care Unit, Department of Pediatrics at Reina, Sofia University Hospital, Córdoba University, Avda.Menéndez Pidal s/n, C.P.14004, Córdoba, Spain
| | - B Ruiz-Sáez
- Pediatric Infectious Diseases, Department At Reina, Sofia University Hospital, Córdoba University, Córdoba, Spain
| | - J L Pérez-Navero
- Pediatric Intensive Care Unit, Department of Pediatrics at Reina, Sofia University Hospital, Córdoba University, Avda.Menéndez Pidal s/n, C.P.14004, Córdoba, Spain
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Yu FNY, Leung KY. Antenatal diagnosis of placenta accreta spectrum (PAS) disorders. Best Pract Res Clin Obstet Gynaecol 2020; 72:13-24. [PMID: 32747328 DOI: 10.1016/j.bpobgyn.2020.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
Antenatal diagnosis of placenta accreta spectrum (PAS) disorders allows planned management by a multidisciplinary team in a tertiary center, and thus can reduce hemorrhagic morbidity, compared with intrapartum diagnosis. Previous Cesarean section and placenta previa are the two most common risk factors. Prenatal ultrasound is a promising diagnostic tool for PAS in the second or third trimester. Recent evidence shows sonographic markers of PAS can be present in the first trimester. Prenatal ultrasound may help predict the depth and topography of placental invasion which are the major determinants of maternal morbidity. The presence of increased vascularity in the inferior part of the lower uterine segment and the parametrial region is associated with a more severe disorder according to a newly proposed staging system. In this chapter, we will discuss how to improve the prediction of PAS, the depth, and topography of placental invasion.
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Affiliation(s)
- Florrie N Y Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - K Y Leung
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong SAR, China; Gleneagles Hong Kong, Hong Kong SAR, China.
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di Pasquo E, Ghi T, Calì G, D'Antonio F, Fratelli N, Forlani F, Prefumo F, Kaihura CT, Volpe N, Dall'Asta A, Frusca T. Intracervical lakes as sonographic marker of placenta accreta spectrum disorder in patients with placenta previa or low-lying placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:460-466. [PMID: 31503353 DOI: 10.1002/uog.21866] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/16/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of a new ultrasound sign, intracervical lakes (ICL), in predicting the presence of placenta accreta spectrum (PAS) disorder and delivery outcome in patients with placenta previa or low-lying placenta. METHODS This was a retrospective multicenter study of women with placenta previa or low-lying placenta at ≥ 26 weeks' gestation, who were referred to three Italian tertiary units from January 2015 to September 2018. The presence of ICL, defined as tortuous anechoic spaces within the cervix which appeared to be hypervascular on color Doppler, was evaluated on ultrasound images obtained at the time of referral. The primary aim was to explore the diagnostic accuracy of ICL in detecting the presence and depth of PAS disorder. The secondary aim was to explore the accuracy of this sign in predicting total estimated blood loss, antepartum bleeding, major postpartum hemorrhage at the time of Cesarean section and need for Cesarean hysterectomy. The diagnostic accuracy of ICL in combination with typical sonographic signs of PAS disorder, was assessed by computing summary estimates of sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios and diagnostic odds ratios (DOR). RESULTS A total of 332 women with placenta previa or low-lying placenta were included in the analysis, with a median maternal age of 33.0 (interquartile range, 29.0-37.0) years. ICL were noted in 15.1% of patients. On logistic regression analysis, the presence of ICL was associated independently with major postpartum hemorrhage (odds ratio (OR), 3.3 (95% CI, 1.6-6.5); P < 0.001), Cesarean hysterectomy (OR, 7.0 (95% CI, 2.1-23.9); P < 0.001) and placenta percreta (OR, 2.8 (95% CI, 1.3-5.8); P ≤ 0.01), but not with the presence of any PAS disorder (OR, 1.6 (95% CI, 0.7-3.5); P = 0.2). Compared with the group of patients without ultrasound signs of PAS disorder, the presence of at least one typical sonographic sign of PAS disorder in combination with ICL had a DOR of 217.2 (95% CI, 27.7-1703.4; P < 0.001) for placenta percreta and of 687.4 (95% CI, 121.4-3893.0; P < 0.001) for Cesarean hysterectomy. CONCLUSION ICL may represent a marker of deep villus invasion in women with suspected PAS disorder on antenatal sonography and anticipate the occurrence of severe maternal morbidity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- E di Pasquo
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Ghi
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - G Calì
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - F D'Antonio
- Department of Obstetrics and Gynaecology, University Hospital of Northern Norway, Tromsø, Norway
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Science, UiT, The Arctic University of Norway, Tromsø, Norway
| | - N Fratelli
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - F Forlani
- Department of Obstetrics and Gynecology, Arnas Civico Hospital, Palermo, Italy
| | - F Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - C T Kaihura
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - N Volpe
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - A Dall'Asta
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
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Wu Q, Yao K, Liu Z, Li L, Zhao X, Wang S, Shang H, Lin Y, Wen Z, Zhang X, Tian J, Wang M. Radiomics analysis of placenta on T2WI facilitates prediction of postpartum haemorrhage: A multicentre study. EBioMedicine 2019; 50:355-365. [PMID: 31767539 PMCID: PMC6921361 DOI: 10.1016/j.ebiom.2019.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Identification of pregnancies with postpartum haemorrhage (PPH) antenatally rather than intrapartum would aid delivery planning, facilitate transfusion requirements and decrease maternal complications. MRI has been increasingly used for placenta evaluation. Here, we aim to build a nomogram incorporating both clinical and radiomic features of placenta to predict the risk for PPH in pregnancies during caesarian delivery (CD). METHODS A total of 298 pregnant women were retrospectively enrolled from Henan Provincial People's Hospital (training cohort: n = 207) and from The Third Affiliated Hospital of Zhengzhou University (external validation cohort: n = 91). These women were suspected with placenta accreta spectrum (PAS) disorders and underwent MRI for placenta evaluation. All of them underwent CD and were singleton. PPH was defined as more than 1000 mL estimated blood loss (EBL) during CD. Radiomic features were selected based on their correlations with EBL. Radiomic, clinical, radiological, clinicoradiological and clinicoradiomic models were built to predict the risk of PPH for each patient. The model with the best prediction performance was validated with its discrimination ability, calibration curve and clinical application. FINDINGS Thirty-five radiomic features showed strong correlation with EBL. The clinicoradiomic model resulted in the best discrimination ability for risk prediction of PPH, with AUC of 0.888 (95% CI, 0.844-0.933) and 0.832 (95% CI, 0.746-0.913), sensitivity of 91.2% (95% CI, 85.8%-96.7%) and 97.6% (95% CI, 92.7%-100%) in the training and validation cohort respectively. For patients with severe PPH (EBL more than 2000 mL), 53 out of 55 pregnancies (96.4%) in the training cohort and 18 out of 18 (100%) pregnancies in the validation cohort were identified by the clinicoradiomic model. The model performed better in patients without placenta previa (PP) than in patients with PP, with AUC of 0.983 compared with 0.867, sensitivity of 100% compared with 90.8% in the training cohort, AUC of 0.832 compared with 0.815, sensitivity of 97.6% compared with 97.2% in the validation cohort. INTERPRETATION The clinicoradiomic model incorporating both prenatal clinical factors and radiomic signature of placenta on T2WI showed good performance for risk prediction of PPH. The predictive model can identify severe PPH with high sensitivity and can be applied in patients with and without PP.
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Affiliation(s)
- Qingxia Wu
- Department of Medical Imaging, Henan Key Laboratory of Neurological Imaging, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China
| | - Kuan Yao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China
| | - Longfei Li
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; Collaborative Innovation Centre for Internet Healthcare, Zhengzhou University, Zhengzhou, Henan, China
| | - Xin Zhao
- Department of Radiology, the Third affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Shuo Wang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China
| | - Honglei Shang
- Department of Radiology, the Third affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yusong Lin
- Collaborative Innovation Centre for Internet Healthcare, Zhengzhou University, Zhengzhou, Henan, China
| | - Zejun Wen
- Department of Radiology, the Third affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xiaoan Zhang
- Department of Radiology, the Third affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China; University of Chinese Academy of Sciences, Beijing, China; Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing, China; Engineering Research Centre of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shanxi, China.
| | - Meiyun Wang
- Department of Medical Imaging, Henan Key Laboratory of Neurological Imaging, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, People's Hospital of Henan University, Zhengzhou, Henan, China.
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Altraigey A, Ellaithy M, Barakat E, Majeed A. Cervical length should be measured for women with placenta previa: cohort study. J Matern Fetal Neonatal Med 2019; 34:2124-2131. [PMID: 31434519 DOI: 10.1080/14767058.2019.1659239] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To study the relevance between cervical length (CL) and different maternal/neonatal outcomes in pregnancies complicated with placenta previa/accreta. METHODS Three hundred twenty-eight women, who had medically free singleton live pregnancies with the diagnosis of placenta previa and/or accreta, were included and divided regarding their CL into two groups. Threatened preterm labor, maternal tocolysis, multiple gestations, polyhydramnios, ruptured fetal membranes, fetal complications, history of cervical conization, and the presence of cervical cerclage were the exclusion criteria. Demographic data, obstetric history, as well as, the courses of the complicated pregnancies were collected and statistically analyzed. RESULTS The short CL group had significantly less distance between the placenta and the internal cervical os (p-value < .001) Also, they showed more ultrasound parameters of complete placenta previa with anterior location (p-value < .001 and .003 respectively) and placental adherence (21.8 versus 41.1%). Women with short cervix had significantly higher rates of preterm birth, antepartum hemorrhage, emergency cesarean sections, intraoperative estimated blood loss, massive bleeding, prevalence of placental adherence and cesarean hysterectomy (p-value < .001 for the entire outcomes). Multivariable binary logistic regression showed that CL (<30 mm) was a significant independent risk factor in prediction of severe hemorrhage, PTB, emergency CS, placental adherence, cesarean hysterectomy (p-value < .001 for adverse maternal outcomes) and low cord Ph (p-value = .016). CONCLUSIONS Assessment of the cervical length could be a crucial step in the work-up and decision making for pregnancies complicated with abnormally situated and/or adherent placenta as it is strongly associated with a wide range of maternal and neonatal morbidities.
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Affiliation(s)
- Ahmed Altraigey
- Department of Obstetrics and Gynaecology, Benha University, Benha, Arab Republic of Egypt.,Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Mohamed Ellaithy
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.,Department of Obstetrics and Gynaecology, Ain Shams University, Cairo, Arab Republic of Egypt
| | - Ehab Barakat
- Department of Obstetrics and Gynaecology, Benha University, Benha, Arab Republic of Egypt
| | - Afshan Majeed
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
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