Article

Cervical length and risk of antepartum bleeding in women with complete placenta previa

Department of Obstetrics and Gynecology, University Hospital of Bologna, Bologna, Italy.
Ultrasound in Obstetrics and Gynecology (Impact Factor: 3.85). 02/2009; 33(2):209-12. DOI: 10.1002/uog.6301
Source: PubMed

ABSTRACT

To evaluate if cervical length predicts prepartum bleeding and emergency Cesarean section in cases of placenta previa.
Between September 2005 and September 2007, cervical length was measured by transvaginal ultrasound in women with complete placenta previa persisting into the third trimester of pregnancy. A complete follow-up of pregnancy was obtained in all cases.
Overall, 59 women were included in the study group. The mean +/- SD gestational age at ultrasound was 30.7 +/- 2.7 weeks and the cervical length was 36.9 +/- 8.8 mm. Cesarean delivery was performed in all cases, at a mean gestational age of 34.7 +/- 2.3 weeks. Twenty-nine (49.1%) of the women presented prepartum bleeding and 12 (20.3%) required an emergency Cesarean section prior to 34 completed weeks due to massive hemorrhage. Cervical length did not differ significantly between cases with and those without prepartum bleeding (35.3 +/- 9.3 mm vs. 38.4 +/- 8.2 mm; P = 0.18), but was significantly shorter among patients who underwent emergency Cesarean section < 34 weeks due to massive hemorrhage compared with patients who underwent elective Cesarean section (29.4 +/- 5.7 mm vs. 38.8 +/- 8.5 mm; P = 0.0006).
Transvaginal sonographic cervical length predicts the risk of emergency Cesarean section < 34 weeks in women with complete placenta previa.

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    • "The reasons for prematurity in anterior placenta remain poorly understood. Previous studies have reported that a short cervical length is associated with preterm delivery not only in women with normal placental position but also in those with placenta previa 18, 19. In this study, although gestational age at delivery was significantly earlier in the anterior groups in complete placenta previa, no significant difference was observed in cervical length at delivery between the anterior and posterior groups. "
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    ABSTRACT: To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery. We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated. Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups. Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.
    Full-text · Article · Sep 2013 · International journal of medical sciences
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    • "Indeed among women with placenta previa, those who had a cervical length <30 mm at the third trimester had a higher rate of preterm delivery and a higher proportion of them required delivery due to hemorrhage in comparison to those with longer cervical length [21]. In addition, Ghi et al. [20] reported that patients with placenta previa who had emergency cesarean section due to bleeding at < 34 weeks of gestation had a significantly shorter cervical length than those who had elective cesarean delivery later during gestation. The authors concluded that a short cervix in patients with placenta previa may herald premature onset of labor and possible detachment of the placenta from its low insertion [20]. "
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    ABSTRACT: Background To determine whether patients with placenta previa who delivered preterm have an increased risk for recurrent spontaneous preterm birth. Methods This retrospective population based cohort study included patients who delivered after a primary cesarean section (n = 9983). The rate of placenta previa, its recurrence, and the risk for recurrent preterm birth were determined. Results Patients who had a placenta previa at the primary CS pregnancy had an increased risk for its recurrence [crude OR of 2.65 (95% CI 1.3-5.5)]. The rate of preterm birth in patients with placenta previa in the primary CS pregnancy was 55.9%; and these patients had a higher rate of recurrent preterm delivery than the rest of the study population (p < .001). Among patients with placenta previa in the primary CS pregnancy, those who delivered preterm had a higher rate of recurrent spontaneous preterm birth regardless of the location of their placenta in the subsequent delivery [OR 3.09 (95% CI 2.1-4.6)]. In comparison to all patients with who had a primary cesarean section, patients who had placenta previa and delivered preterm had an independent increased risk for recurrent preterm birth [OR of 3.6 (95% CI 1.5-8.5)]. Conclusions Women with placenta previa, who deliver preterm, especially before 34 weeks of gestation, are at increased risk for recurrent spontaneous preterm birth regardless to the site of placental implantation in the subsequent pregnancy. Thus, strict follow up by high risk pregnancies specialist is recommended.
    Full-text · Article · Aug 2012 · BMC Pregnancy and Childbirth
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    • "It is common practice to measure the cervical length using transvaginal ultrasound to predict preterm delivery. It is interesting to note that Ghi et al reported a possible association between the cervical length and the risk of preterm hemorrhage in patients with complete placenta previa [5]. Although the cervical length did not differ significantly between cases with and without prepartum bleeding, it was significantly shorter among patients who underwent an emergency Cesarean section at <34 weeks, due to massive hemorrhage compared with patients who underwent an elective Cesarean section. "
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    ABSTRACT: Placenta previa poses a high risk for massive hemorrhage, from the antenatal period until after Cesarean section. This condition increases the risk of maternal and neonatal mortality and morbidity. In cases of placenta previa, the prenatal prediction of sudden bleeding during pregnancy and blood loss during Cesarean section, and the assessment of risk for adherence of the placenta using an ultrasound examination, can improve the perinatal outcome. Therefore, ultrasonographic findings associated with the prediction of massive bleeding in cases of placenta previa are reviewed in this article.
    Full-text · Article · Mar 2012 · Taiwanese journal of obstetrics & gynecology
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