Cervical Length Monitoring in Placenta Previa to Predict Emergency Cesarean Section for Antepartum Hemorrhage [06M

Abstract

INTRODUCTION: Placenta previa can cause significant obstetric hemorrhage and present as grave emergency, leading to adverse maternal and perinatal outcome. We conducted a prospective observational study to determine if cervical length (CL) ≤3 cm correlates with emergency Cesarean section (CS) for Antepartum hemorrhage (APH). METHODS: Transvaginal sonographic CL was measured for women with placenta previa beyond 26 weeks and then at two weekly intervals. Emergency CS due to APH, APH episodes, gestation at delivery and baby’s birth weight were compared between women with CL ≤3 cm (group 1) and CL >3 cm (group 2), measured at the time of recruitment. The study was approved by the local Institutional Ethics Committee. RESULTS: Seventy-one women were included, out of which seven delivered vaginally and 64 underwent CS. More women required emergency CS in group 1 (19/32, 59.4%) than in group 2 (14/32, 43.8%) (P=.211). With serial monitoring, short CL ≤3 cm was significantly associated with emergency CS within two weeks (21/32 (65.6%) vs. 12/32 (37.5%), P=.024). Women with short CL ≤3 cm delivered earlier (35.4±2.0 weeks vs. 36.1±2.3 weeks in group 1 &2 respectively, P=.005). Number of APH episodes was higher in group 1 as compared to group 2 (2.2±1.4 vs. 1.5±1.4, P=.024). Women with CL >3 cm delivered neonates with higher birth weight as compared to those with CL ≤3 cm (2.56±0.6 kg vs. 2.3±0.5 kg, P=.046). CONCLUSION: Cervical length ≤3 cm is associated with more APH episodes, lower gestation and baby weight at birth in women with placenta previa. Serial monitoring of CL may predict need for emergency CS and help plan admission and delivery.