Abstract
PurposeTo evaluate whether serial change in cervical length (CL) over time can be a predictor for emergency cesarean section (CS) in patients with placenta previa.MethodsThis was a retrospective cohort study of patients with placenta previa between January 2010 and November 2014. All women were offered serial measurement of CL by transvaginal ultrasound at 19 to 23 weeks (CL1), 24 to 28 weeks (CL2), 29 to 31 weeks (CL3), and 32 to 34 weeks (CL4). We compared clinical characteristics, serial change in CL, and outcomes between the emergency CS group (case group) and elective CS group (control group). The predictive value of change in CL for emergency CS was evaluated.ResultsA total of 93 women were evaluated; 31 had emergency CS due to massive vaginal bleeding. CL tended to decrease with advancing gestational age in each group. Until 29–31 weeks, CL showed no significant differences between the two groups, but after that, CL in the emergency CS group decreased abruptly, even though CL in the elective CS group continued to gradually decrease. On multivariate analysis to determine risk factors, only admissions for bleeding (odds ratio, 34.710; 95% CI, 5.239–229.973) and change in CL (odds ratio, 3.522; 95% CI, 1.210–10.253) were significantly associated with emergency CS. Analysis of the receiver operating characteristic curve showed that change in CL could be the predictor of emergency CS (area under the curve 0.734, p < 0.001), with optimal cutoff for predicting emergency cesarean delivery of 6.0 mm.ConclusionsPrevious admission for vaginal bleeding and change in CL are independent predictors of emergency CS in placenta previa. Women with change in CL more than 6 mm between the second and third trimester are at high risk of emergency CS in placenta previa. Single measurements of short CL at the second or third trimester do not seem to predict emergency CS.
Highlights
Placenta previa is one of the most serious complications during pregnancy, because of possible emergency cesarean section (CS) if abrupt and massive hemorrhage occurs in the antepartum period
cervical length (CL) tended to decrease with advancing gestational age in each group
On multivariate analysis to determine risk factors, only admissions for bleeding and change in CL were significantly associated with emergency CS
Summary
Placenta previa is one of the most serious complications during pregnancy, because of possible emergency cesarean section (CS) if abrupt and massive hemorrhage occurs in the antepartum period. It is not easy to predict the risk of maternal bleeding and premature delivery in asymptomatic women. Maternal and neonatal morbidity would improve in patients with placenta previa, if the risk of bleeding during pregnancy could be predicted. In theory, such complications (maternal hemorrhage, prematurity) could be expected more frequently in patients whose risk of preterm labor is increased [2]. In addition to a single measurement of CL, a recent study focused on the relationship between the change in CL over time and preterm CS following massive hemorrhage in women with placenta previa [13]. No previous studies evaluated the clinical value of cervical changes in predicting adverse perinatal outcomes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
