Shorter the cervix, more difficult the placenta percreta operations

Polat, Mesut; Kahramanoğlu, İlker; Şenol, Taylan; Özkaya, Enis; Karateke, Ateş

doi:10.3109/14767058.2015.1085017

Cited by 17 publications

(19 citation statements)

References 18 publications

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“…Treatment of abnormal placental invasion above the lower uterine segment has higher success rates compared with placental invasion in the lower uterine segment (lower bladder, cervix, parametrium, and posterior placental invasion) in PAS with placenta previa. Detailed preoperative placental mapping using MRI or ultrasound (abdominal/transvaginal gray‐scale, abdominal/transvaginal Doppler, three‐dimensional Doppler, three‐dimensional volume‐rendering ultrasound) have a critical role in predetermining the success of uterine conservative surgery 40 . In emergency situations like preoperative massive vaginal bleeding with hemodynamically compromised pregnant women, we do not recommend uterine conservative surgery.…”

Section: Discussionmentioning

confidence: 99%

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Aryananda

Aditiawarman

Gumilar

et al. 2022

Acta Obstet Gynecol Scand

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Introduction:The incidence of placenta accreta spectrum (PAS) has increased, but the optimal management and the optimal way to achieve vascular control are still controversial. This study aims to compare maternal outcomes between different methods of vascular control in surgical PAS management. Material and methods: A retrospective cohort study on consecutive cases diagnosed with PAS between 2013 and 2020 in single tertiary hospital. The final diagnosis of PAS was made following preoperative ultrasound and confirmation during surgery. Management of PAS using cesarean hysterectomy with internal iliac artery ligation (IIAL) was compared with two types of vascular control in uterine conservativeresective surgery (IIAL vs identification-ligation of the upper vesical, upper vaginal, and uterine arteries).Results: Over an 8-year period, 234 pregnant women were diagnosed with PAS meeting the inclusion criteria. Uterine conservative-resective surgery (200 cases) was associated with lower mean blood loss compared with cesarean hysterectomy with IIAL (34 cases) in all PAS cases (1379 ± 769 mL vs 3168 ± 1916 mL; p < 0.001). In subanalysis of the two uterine conservative-resective surgery subgroups, the group with identification-ligation of the upper vesical, upper vaginal, and uterine arteries had a significantly lower blood loss compared with uterine conservative-resective surgery with IIAL (1307 ± 743 mL vs 1701 ± 813 mL; p = 0.005). Women in the hysterectomy with IIAL group had more massive transfusion (35.3% vs 2.5%; p < 0.001; odds ratio[OR] 21.3, 95% confidence interval [CI] 6.9-66), major blood loss (>1500 mL) (70.6% vs 34%, p < 0.001; OR 4.7; 95% CI 2.1-10.3), catastrophic blood loss (>2500 mL)

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Section: Discussionmentioning

confidence: 99%

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Aryananda

Aditiawarman

Gumilar

et al. 2022

Acta Obstet Gynecol Scand

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“…e cervix, a special part of the uterus, is normally located in the deep position of the female pelvic cavity, mainly composed of connective tissue, with few smooth muscle fibers, blood vessels, and elastic fibers, and mainly receiving blood supply from the descending branch of uterine artery and part of vaginal artery. Once the placenta invades the cervix, the blood flow of the cervix increases, and the difficulties such as poor contraction of myometrium, wide bleeding wound, fast bleeding speed, and difficulty in stopping bleeding easily occur in the process of placental abruption [9], which seriously perplex the majority of obstetricians.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, based on the idea that changes of cervical morphology could reflect the changes of cervical load and surrounding structure, the observation indexes of cervical morphology have been gradually brought into the scope of imaging examination of placenta previa with placenta accrete. Polat et al [9] thought that cervical shortening seemed to be a warning sign of placenta previa with penetration. Our study showed that the cervical length of PAS patients complicated with cervical implantation was significantly shorter than that of lower uterine implantation, which was consistent with Polat M's study.…”

Section: Discussionmentioning

confidence: 99%

Early Warning Model of Placenta Accreta Spectrum Disorders Complicated with Cervical Implantation: A Single-Center Retrospective Study

Xin

Wan

Zeng

et al. 2022

Journal of Healthcare Engineering

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Background. Placenta accreta spectrum (PAS) disorders seriously threaten the safety of the mother and infant in the perinatal period. Moreover, PAS is associated with poor maternal and perinatal outcomes once complicated with cervical implantation. Dismally, there are few reports about PAS complicated with cervical involvement currently, and the early warning models are also rarely reported. To screen the risk factors of PAS complicated with cervical implantation and construct an early risk warning model, we performed the analysis of clinical indicators and images of PAS patients by artificial intelligence (AI) data processing methods. Methods. The clinical data of 166 patients with PAS in our hospital from January 2016 to September 2020 were retrospectively analyzed. The patients were divided into cervical implantation group and lower uterine implantation group according to the position of placenta implantation. Then, we compared the pregnancy outcomes of the two groups, screened the possible related factors of PAS complicated with cervical implantation by univariate analysis, and established the early warning model by logistic regression analysis. Results. The maternal outcome of PAS complicated with cervical implantation was worse than that of the lower uterine implantation group. Through univariate analysis and logistic regression analysis, we found that the cervical width, abundant cervical blood flow, and bladder line interruption were all risk factors of PAS complicated with cervical implantation, and their contribution to the establishment of the regression model was statistically significant. Conclusion. PAS complicated with cervical implantation was extremely severe. Early identification of risk factors and establishment of a risk warning model have certain guiding significance for clinical formulation of a reasonable treatment plan.

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“…[20] What is more, short cervix appears to be one of the warning signs for elevated difficulty in the operations for placenta previa/percreta. [12] A previous ultrasound study showed that women with IPP had shorter cervical lengths at 32 to 34 weeks than women with a non-adherent low-lying placenta or placenta previa. [21] Our results showed that patients with the S2 involvement had shorter cervical lengths than the patients with the S1 invasion.…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that the cervical length has a vital impact on the clinical outcomes of patients undergoing peripartum hysterectomy due to placenta previa/percreta. [12] However, the cervical morphology of invasive placenta previa (IPP) is less studied. Therefore, the purpose of our study is to investigate the role of cervical morphology evaluated by MRI in predicting IPP.…”

Section: Introductionmentioning

confidence: 99%

Morphological evaluation of cervix using MRI at 32 to 36 weeks of gestation

Liu¹,

Chen

Wei³

et al. 2018

Medicine

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This study is to investigate the role of cervical morphology evaluated by magnetic resonance imaging (MRI) in predicting invasive placenta previa (IPP).Totally 105 cases of pregnant women underwent prenatal placental MRI at 32 to 36 weeks of gestation for suspected IPP were included in this study. Cervical morphology (cervical length and placental protrusion) was evaluated independently by 2 radiologists. The association between the cervical morphology and surgery findings was analyzed.Totally, 57 pregnant women were confirmed as IPP. For invasion degree, there were 17 cases with placenta percreta and 40 with accreta. For invasion topography, there were 27 cases with S1 invasion and 30 with S2 invasion. The sensitivity and specificity for the MRI sign of placental protrusion in evaluating cervical invasion of IPP were 100% and 100%, respectively. All the 7 IPP patents with cervical invasion received total hysterectomy and had severe blood loss (3500–6000 mL). The IPP patients with S2 invasion had shorter cervical length than those with S1 invasion (2.66 ± 0.66 cm vs 3.24 ± 0.64 cm, P <.001). However, cervical lengths did not correlate with the degree of invasion (placenta percreta vs placenta accreta: 2.82 ± 0.86 vs 2.99 ± 0.60, P = .21).Placental protrusion is a reliable MRI sign for cervical invasion of IPP, and cervical lengths correlate with the invasion topography.

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Shorter the cervix, more difficult the placenta percreta operations

Abstract: Short cervix appears to be a cause of difficulty in placenta previa/percreta operations. CL may also help in determining the timing of delivery in placenta percreta patients.

Cited by 17 publications

References 18 publications

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Uterine conservative–resective surgery for selected placenta accreta spectrum cases: Surgical–vascular control methods

Early Warning Model of Placenta Accreta Spectrum Disorders Complicated with Cervical Implantation: A Single-Center Retrospective Study

Morphological evaluation of cervix using MRI at 32 to 36 weeks of gestation

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