Published: 2017-10-28

Placenta accreta and emergency cesarean delivery correlates to cervical length and transcervical placental thickness measurement

Nahla W. Shady, Hany F. Sallam, Ahmed M. Abbas


Background: The study aims to evaluate the effect of cervical length and the transcervical placental thickness measurement at 28-30 weeks gestation in predicting the risk of antepartum haemorrhage (APH) and emergency preterm caesarean delivery (CD) in women with placenta previa accreta.

Methods: A prospective cohort study conducted at Aswan university hospital from June 2015 to April 2017 included one hundred and five cases diagnosed as placenta previa accreta by transvaginal ultrasound (TVS) between 28-30 weeks gestation were divided into three groups according to their cervical length which measured by TVS: group I (cervical length >30 mm), group II (cervical length 20-30 mm) and group III (cervical length <20 mm). Also, placental thickness measurement was done. Cervical length and placental thickness and correlated with the clinical outcome regarding to gestational age at delivery, APH, emergency CD due to massive haemorrhage, the need for blood transfusion and caesarean hysterectomy.

Results: APH and emergency CD due to massive bleeding were significantly higher in cases with short cervical length and thick placenta. APH occurred in 6 cases (15%) in group I, 14 cases (40%) in group II and 24 cases (80%) in group III, (p=0.0001). Emergency CD in group I was performed in 5 cases (12.5 %), 12 cases (34.3 %) in group II and 24 cases (80%) in group III, (p =0.0001). The incidence of APH was higher in thick placenta [6 cases (42.9 %) compared to none with thin placenta in group I (p=0.001), 13 cases (68.4%) compared to one case (6.2%) in group II (p=0.0001) and 21 cases (100%) compared to 3 cases (33.3%) in group III (p=0.0001)].

Conclusions: Short cervical length and increased placental thickness may predict the risk of APH and emergency preterm CD in patients with placenta accreta.


Cervical length, Cesarean delivery, Placental thickness, Placenta accreta

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Tseng JJ, Chou MM, Hsiehb YT, Wene MC, Hob ES, Hsuf SL. Differential expression of vascular endothelial growth factor, placenta growth factor and their receptors in placentae from pregnancies complicated by placenta accreta. Placenta. 2006;27:70-8.

Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. 2006;107:927-41.

Mohan P, Bajwa S, Sharma S, Kaur P. Placenta percreta-an obstetrician’s nightmare. Sri Lanka J Obstet Gynecol. 2010;32(2):39-40.

Likis FE, Sathe NA, Morgans AK, Hartmann KE, Young JL, Carlson-Bremer D, et al. Management of Postpartum Hemorrhage. Rockville (MD): Agency for Healthcare Research and Quality (US). 2015:15-EHC013-EF.

American College of Obstetricians and Gynecologists Placenta accreta. Committee Opinion No. 529. 2012;120:207-11.

Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, et al. William’s Obstetrics. 24th edition. McGraw-Hill Education; 2014:806.

Warshak CR, Ramos GA, Eskander R, Benirschke K, Saenz CC, Kelly TF, et al. Effect of predelivery diagnosis in 99 consecutive cases of placenta accreta. Obstet Gynecol. 2010;115(1):65-9.

Eller AG, Bennett MA, Sharshiner M, Masheter C, Soisson AP, Dodson M, et al. Maternal morbidity in cases of placenta accreta managed by a multidisciplinary care team compared with standard obstetric care. Obstet Gynecol 2011;117(2)(1):331-7.

Walker MG, Allen L, Windrim RC, Kachura J, Pollard L, Pantazi S, et al. Multidisciplinary management of invasive placenta previa. J Obstet Gynaecol Can. 2013;35(5):417-25.

Robinson CJ, Villers MS, Johnson DD, Simpson KN. Timing of elective repeat cesarean delivery at term and neonatal outcomes: a cost analysis. Am J Obstet Gynecol. 2010;202(6):632.e1-632.e6.

Esakoff TF, Handler SJ, Granados JM, Caughey AB. PAMUS: Placenta accreta management across the United States. J Matern Fetal Neonatal Med. 2012;25(6):761-5.

Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL, et al. Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. J Matern Fetal Neonatal Med. 2013;26(16):1602-9.

Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol. 2015;126:654-68.

Robinson BK, Grobman WA. Effectiveness of timing strategies for delivery of individuals with placenta previa and accreta. Obstet Gynecol. 2010;116:835-42.

Silver R, Depp R, Sabbagha RE, Dooley SL, Socol ML, Tamura RK. Placenta previa: aggressive expectant management. Am J Obstet Gynecol. 1984;150:15-22.

Brenner WF, Edelman DA, Hendricks CH. Characteristics of patients with placenta previa and results of “expectant management”. Am J Obstet Gynecol. 1978;132:180-91.

Wright JD, Pri-Paz S, Herzog TJ, Shah M, Bonanno C, Lewin SN, et al. Predictors of massive blood loss in women with placenta accreta. Am J Obstet Gynecol. 2011;205:38.e1-6

Watanabe N, Suzuki T, Ogawa K,Kubo T, Sago H. Five-year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women. J Obstet Gynaecol Res. 2011;37(12):1773-7.

McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol. 2008;111:35-41.

Bates E, Rouse DJ, Mann ML, Chapman V, Carlo WA, Tita AT. Neonatal outcomes after demonstrated fetal lung maturity before 39 weeks of gestation. Obstet Gynecol. 2010;116:1288-95.

Briery CM, Rose CH, Hudson WT, Lutgendorf MA, Magann EF, Chauhan SP, et al. Planned versus emergent cesarean hysterectomy. Am J Obstet Gynecol. 2007;197:154.e1-5.

Rozenberg P, Gillet A, Ville Y. Transvaginal sonographic examination of the cervix in asymptomatic pregnant women: review of the literature. Ultrasound Obstet Gynecol. 2002;19:302-11.

Palacio M, Sanin-Blair J, S´anchez M, Crispi F, G´omezO, Carreras E, et al. The use of a variable cut-off value of cervical length in women admitted for preterm labor before and after 32 weeks. Ultrasound Obstet Gynecol. 2007;29:421-6.

Oyelese Y, Smulian JC. Placenta praevia, placenta accreta, and vasa praevia. ObstetGynecol. 2006;107:927-41.

Ruiter L, Eschbach SJ, Burgers M, Rengerink KO, vab Pampus MG, Goes BY, et al. Predictors of emergent caesarean delivery in women with placenta previa. Am J Perinatol. 2016;33(14):1407-14.

Ghi T, Contro E, Martina T, Piva M, Morandi R, Orsini LF, et al. Cervical length and the risk of antepartum bleeding in women with complet placenta previa. Ultrasound Obestet Gynecol. 2009;33(2):209-12.

Stafford IA, Dshe JS, Shiwera SA, Alexander JM, McIntire DD, Leveno KJ. Ultrasound cervical length and the risk of hemorrhage in pregnancies with placenta previa. Obstet Gynecol. 2010;116:595-600.

Sekiguchi A, Nakai A, Okuda N, IndeY, Takashita T. Consecutive cervical length measurements as a predictor of preterm cesarean section in complete placenta previa. J Clin Ultrasound. 2015;43:17-22.

Zaitoun MM, El Behery MM, El Hameed AAA, Soliman BS. Does cervical length and the lower placental edge thickness measurement correlates with clinical outcome in cases of complete placenta previa? Arch Gynecol Obstet. 2011;284:867-73.

Fukushima K, Fujiwara A, Anami A, Fujita Y, Yumoto Y, Sakai A, et al. Cervical length predicts placental adherence and massive hemorrhage in placenta previa. J Obstet Gynaecol Res. 2012;38(1):192-7.

Ghourab S. Third-trimester transvaginal ultrasonography in placenta previa: does the shape of the lower placental edge predict clinical outcome. Ultrasound Obstet Gynecol. 2001;18:103-8.