Research Article

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa

Liping Zhou BS

Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China

Search for more papers by this author

Xuepiao Zhao BS,

Xuepiao Zhao BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Duo Xu MD,

Duo Xu MD

Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China

Search for more papers by this author

Suhua Pang RN,

Suhua Pang RN

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Xiuzhen Mao BS,

Xiuzhen Mao BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Shixiang Feng BS,

Shixiang Feng BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Yongfei Yue MD,

Corresponding Author

Yongfei Yue MD

[email protected]

orcid.org/0000-0001-8956-1979

Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China

Address reprint requests to: Y.Y., Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, No. 26 Daoqian Street, Gusu District, Suzhou, Jiangsu, 215002, China. E-mail: [email protected]

Search for more papers by this author

Liping Zhou BS,

Liping Zhou BS

Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China

Search for more papers by this author

Xuepiao Zhao BS,

Xuepiao Zhao BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Duo Xu MD,

Duo Xu MD

Department of Obstetrics and Gynecology, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, Guangdong, China

Search for more papers by this author

Suhua Pang RN,

Suhua Pang RN

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Xiuzhen Mao BS,

Xiuzhen Mao BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Shixiang Feng BS,

Shixiang Feng BS

Department of Obstetrics and Gynecology, The Affiliated SuQian first people’s Hospital of Nanjing Medical University, SuQian, Jiangsu, China

Search for more papers by this author

Yongfei Yue MD,

Corresponding Author

Yongfei Yue MD

[email protected]

orcid.org/0000-0001-8956-1979

Department of Obstetrics and Gynecology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China

Search for more papers by this author

First published: 27 February 2023

https://doi.org/10.1002/jmri.28617

Contract grant sponsor: Maternal and Children's Health Research Project of Jiangsu Province; Contract grant numbers: F202108, F202049; Contract grant sponsor: Suzhou Science and Technology Plan Research Project; Contract grant numbers: SKJYD2021222, SYSD2020133.

Share a link

Email
Wechat
Bluesky

Abstract

Background

Complete placenta previa is associated with a higher percentage of adverse clinical outcomes and magnetic resonance imaging (MRI) is widely used in the preoperative examination of patients with placenta previa.

Purpose

To evaluate the effectiveness of the placental area in the lower uterine segment and cervical length in identifying the adverse maternal–fetal outcomes in women with complete placenta previa.

Study Type

Retrospective.

Population

A total of 141 pregnant women (median age, 32; age range, 24–40 years) with complete placenta previa were examined by MRI to evaluate the uteroplacental condition.

Field Strength/Sequence

A 3 T with T₁-weighted imaging (T₁WI), T₂-weighted imaging (T₂WI), and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence.

Assessment

The association of the placental area in the lower uterine segment and cervical length measured using MRI with the risk of massive intraoperative hemorrhage (MIH) and maternal–fetal perinatal outcomes were determined. The adverse neonatal outcomes (preterm delivery, respiratory distress syndrome [RDS], admission to neonatal intensive care unit [NICU]) were analyzed in different groups.

Statistical Tests

The t-test, Mann-Whitney U test, Chi-square, Fisher's exact test, and receiver operating characteristic (ROC) curve were used, and a P < 0.05 indicated a statistically significant difference.

Results

The mean operation time, intraoperative blood loss, and intraoperative blood transfusing were significantly higher in patients with large placental area and short cervix than in patients with the small placental area and long cervix, respectively. The incidence of adverse neonatal outcomes was significantly higher in the large placenta area group and short cervix group than in the small placenta group area and long cervix group, respectively, such as preterm delivery, RDS, and NICU. By combining placental area with cervical length sensitivity and specificity increased to 93% and 92%, respectively, for the identification of MIH > 2000 mL with area under the receiver operating curve (AUC) 0.941.

Data Conclusion

Large placental area and short cervical length may be associated with a high risk of MIH and adverse maternal–fetal perinatal outcomes in patients with complete placenta previa.

Level of Evidence

Technical Efficacy Stage

References

1Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol 2006; 107: 927-941.
10.1097/01.AOG.0000207559.15715.98
PubMed Web of Science® Google Scholar
2Becker RH, Vonk R, Mende BC, Ragosch V, Entezami M. The relevance of placental location at 20-23 gestational weeks for prediction of placenta previa at delivery: Evaluation of 8650 cases. Ultrasound Obstet Gynecol 2001; 17: 496-501.
10.1046/j.1469-0705.2001.00423.x
CAS PubMed Web of Science® Google Scholar
3Solheim KN, Esakoff TF, Little SE, Cheng YW, Sparks TN, Caughey AB. The effect of cesarean delivery rates on the future incidence of placenta previa, placenta accreta, and maternal mortality. J Matern Fetal Neonatal Med 2011; 24: 1341-1346.
10.3109/14767058.2011.553695
PubMed Web of Science® Google Scholar
4Downes KL, Hinkle SN, Sjaarda LA, Albert PS, Grantz KL. Previous prelabor or intrapartum cesarean delivery and risk of placenta previa. Am J Obstet Gynecol 2015; 212(669): e1-e6.
PubMed Web of Science® Google Scholar
5Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011; 284: 47-51.
10.1007/s00404-010-1598-7
PubMed Web of Science® Google Scholar
6Baumfeld Y, Herskovitz R, Niv ZB, Mastrolia SA, Weintraub AY. Placenta associated pregnancy complications in pregnancies complicated with placenta previa. Taiwan J Obstetr Gynecol 2017; 56: 331-335.
10.1016/j.tjog.2017.04.012
PubMed Web of Science® Google Scholar
7Jauniaux E, Collins S, Burton GJ. Placenta accreta spectrum: Pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. Am J Obstet Gynecol 2018; 218: 75-87.
10.1016/j.ajog.2017.05.067
PubMed Web of Science® Google Scholar
8Einerson BD, Rodriguez CE, Kennedy AM, Woodward PJ, Donnelly MA, Silver RM. Magnetic resonance imaging is often misleading when used as an adjunct to ultrasound in the management of placenta accreta spectrum disorders. Am J Obstet Gynecol 2018; 218: 618.e1-618.e7.
10.1016/j.ajog.2018.03.013
PubMed Web of Science® Google Scholar
9Gibbins KJ, Einerson BD, Varner MW, Silver RM. Placenta previa and maternal hemorrhagic morbidity. J Matern Fetal Neonatal Med 2018; 31: 494-499.
10.1080/14767058.2017.1289163
PubMed Web of Science® Google Scholar
10Shamshirsaz AA, Fox KA, Salmanian B, et al. Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach. Am J Obstet Gynecol 2015; 212: 218.e1-218.e9.
10.1016/j.ajog.2014.08.019
PubMed Web of Science® Google Scholar
11Alshammary E, Elmuzaini MF. Successful conservative treatment of multiorgan infiltrating placenta percreta by uterine embolization and follow up with serial magnetic resonance. A case report. Int J Surg Case Rep 2019; 58: 216-219.
10.1016/j.ijscr.2019.04.012
PubMed Web of Science® Google Scholar
12Polat M, Kahramanoglu I, Senol T, Ozkaya E, Karateke A. Shorter the cervix, more difficult the placenta percreta operations. J Matern Fetal Neonatal Med 2016; 29: 2327-2331.
10.3109/14767058.2015.1085017
PubMed Web of Science® Google Scholar
13Einerson BD, Rodriguez CE, Silver RM, Donnelly MA, Kennedy AM, Woodward PJ. Accuracy and interobserver reliability of magnetic resonance imaging for placenta accreta spectrum disorders. Am J Perinatol 2021; 38: 960-967.
10.1055/s-0040-1701196
PubMed Web of Science® Google Scholar
14Altraigey A, Ellaithy M, Barakat E, Majeed A. Cervical length should be measured for women with placenta previa: Cohort study. J Matern Fetal Neonatal Med 2021; 34: 2124-2131.
10.1080/14767058.2019.1659239
PubMed Web of Science® Google Scholar
15Syed W, Liaqat N, Naseeb G, Khattak SM. Relationship of placental edge thickness and cervical length to gestational age at delivery in patients with placenta previa. Pak J Med Sci 2022; 38: 1349-1352.
10.12669/pjms.38.5.5097
PubMed Web of Science® Google Scholar
16Jauniaux E, Ayres–De–Campos D, Langhoff–Roos J, Fox KA, Collins S. FIGO classification for the clinical diagnosis of placenta accreta spectrum disorders. Int J Gynaecol Obstet 2019; 146: 20-24.
10.1002/ijgo.12761
PubMed Web of Science® Google Scholar
17Paily VP, Sidhik A, Girijadevi RR, et al. Managing placenta accreta spectrum in low-resource settings using a novel dissection-free aorta clamp: Operative technique. Int J Gynaecol Obstet 2022; 158: 469-475.
10.1002/ijgo.14196
PubMed Web of Science® Google Scholar
18Calvache AJ, Calvache JP, Hidalgo A, et al. Placenta accreta spectrum prenatal diagnosis performance: Are ultrasound false-positive results acceptable in limited-resources settings? Rev Bras Ginecol Obstet 2022; 44: 838-844.
10.1055/s-0042-1751061
PubMed Web of Science® Google Scholar
19Visconti F, Quaresima P, Rania E, et al. Difficult caesarean section: A literature review. Eur J Obstet Gynecol Reprod Biol 2020; 246: 72-78.
10.1016/j.ejogrb.2019.12.026
PubMed Web of Science® Google Scholar
20Park HS, Cho HS. Management of massive hemorrhage in pregnant women with placenta previa. Anesth Pain Med (Seoul) 2020; 15: 409-416.
10.17085/apm.20076
PubMed Google Scholar
21Carusi DA. The placenta accreta spectrum: Epidemiology and risk factors. Clin Obstet Gynecol 2018; 61: 733-742.
10.1097/GRF.0000000000000391
PubMed Web of Science® Google Scholar
22Kumar I, Verma A, Ojha R, Shukla RC, Jain M, Srivastava A. Invasive placental disorders: A prospective US and MRI comparative analysis. Acta Radiol 2017; 58: 121-128.
10.1177/0284185116638567
PubMed Web of Science® Google Scholar
23Zaghal AA, Hussain HK, Berjawi GA. MRI evaluation of the placenta from normal variants to abnormalities of implantation and malignancies. J Magn Reson Imaging 2019; 50: 1702-1717.
10.1002/jmri.26764
PubMed Web of Science® Google Scholar
24Tikkanen M, Paavonen J, Loukovaara M, Stefanovic V. Antenatal diagnosis of placenta accreta leads to reduced blood loss. Acta Obstet Gynecol Scand 2011; 90: 1140-1146.
10.1111/j.1600-0412.2011.01147.x
PubMed Web of Science® Google Scholar
25Warshak CR, Ramos GA, Eskander R, et al. Effect of predelivery diagnosis in 99 consecutive patients of placenta accreta. Obstet Gynecol 2010; 115: 65-69.
10.1097/AOG.0b013e3181c4f12a
PubMed Web of Science® Google Scholar
26Zheng X, Li T, Zeng M, Cheng XB, Rao HY. The clinical value of prenatal assessment of cervical length and placental thickness in pregnant women with placenta previa. Am J Transl Res 2021; 13: 5308-5314.
PubMed Web of Science® Google Scholar
27Chen DJ, Xu JF, Ye PF, et al. Risk scoring system with MRI for intraoperative massive hemorrhage in placenta previa and accreta. J Magn Reson Imaging 2020; 51: 947-958.
10.1002/jmri.26922
PubMed Web of Science® Google Scholar
28Hou SY, Song Y, Wu JH, et al. Comparison of magnetic resonance imaging of the lower uterine segment in pregnant women with central placenta previa with and without placenta accreta spectrum from a single center. Med Sci Monit 2021; 27:e932759.
10.12659/MSM.932759
PubMed Web of Science® Google Scholar
29Ghi T, Contro E, Martina T, et al. Cervical length and risk of antepartum bleeding in women with complete placenta previa. Ultrasound Obstet Gynecol 2009; 33: 209-212.
10.1002/uog.6301
CAS PubMed Web of Science® Google Scholar
30Stafford IA, Dashe JS, Shivvers SA, Alexander JM, McIntire DD, Leveno KJ. Ultrasonographic cervical length and risk of hemorrhage in pregnancies with placenta previa. Obstet Gynecol 2010; 116: 595-600.
10.1097/AOG.0b013e3181ea2deb
PubMed Web of Science® Google Scholar
31Jauniaux E, Bhide A, Kennedy A, et al. FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. Int J Gynaecol Obstet 2018; 140: 274-280.
10.1002/ijgo.12408
PubMed Web of Science® Google Scholar
32Li Y, Luan X, Chen D, et al. Use of anti-arcuate compression suturing in pernicious placenta previa with accrete spectrum disorders: A surgical technique. Med Sci Monit 2020; 26:e922958.
10.12659/MSM.922958
PubMed Web of Science® Google Scholar
33Oyelese Y, Smulian JC. Placenta praevia, placenta accreta, and vasa praevia. Obstet Gynecol 2006; 107: 927-941.
10.1097/01.AOG.0000207559.15715.98
PubMed Web of Science® Google Scholar

Volume58, Issue4

October 2023

Pages 1047-1054

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Level of Evidence

Technical Efficacy Stage

References

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Placental Area in the Lower Uterine Segment, Cervical Length, and Clinical Outcome in Pregnancies With Complete Placenta Previa

Abstract

Background

Purpose

Study Type

Population

Field Strength/Sequence

Assessment

Statistical Tests

Results

Data Conclusion

Level of Evidence

Technical Efficacy Stage

References

References

Related

Information