Rac Martha W F, McIntire Donald D, Wells C Edward, Moschos Elysia, Twickler Diane D
Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
J Ultrasound Med. 2017 Jul;36(7):1431-1436. doi: 10.7863/ultra.16.05059. Epub 2017 Mar 24.
To evaluate cervical length measurements in women with placenta accreta compared to women with a nonadherent low-lying placenta or placenta previa and evaluate this relationship in terms of vaginal bleeding, preterm labor, and preterm birth.
We conducted a retrospective cohort study between 1997 and 2011 of gravidas with more than 1 prior cesarean delivery who had a transvaginal ultrasound examination between 24 and 34 weeks for a low-lying placenta or placenta previa. Cervical length was measured from archived images in accordance with national guidelines by a single investigator, who was blinded to outcomes and ultrasound reports. The diagnosis of placental accreta was based on histologic confirmation. For study purposes, preterm birth was defined as less than 36 weeks, and cervical lengths of 3 cm or less were considered short. Standard statistical analyses were used.
A total of 125 patients met inclusion criteria. The cohort was divided into patients with (n = 43 [34%]) and without (n = 82 [66%]) placenta accreta and stratified by gestational age at the ultrasound examinations. Women with placenta accreta had shorter cervical length measurements during their 32- to 34-week ultrasound examinations (mean ± SD, 3.23 ± 0.98 versus 3.95 ± 1.0 cm; P < .01) and were more likely to have a short cervix of 3 cm or less (P = .001). However, these findings did not correlate with the degree of invasion (P = .3), or higher rates of vaginal bleeding and preterm labor (P = .19) resulting in preterm birth before 36 weeks (P = .64).
Women with placenta accreta had shorter cervical lengths at 32 to 34 weeks than women with a nonadherent low-lying placenta or placenta previa, but this finding did not correlate with a higher risk of vaginal bleeding or preterm labor resulting in preterm birth before 36 weeks.
比较胎盘植入妇女与低置胎盘或前置胎盘未粘连妇女的宫颈长度测量值，并从阴道出血、早产和早产方面评估这种关系。
我们对1997年至2011年间有1次以上剖宫产史、因低置胎盘或前置胎盘在24至34周接受经阴道超声检查的孕妇进行了一项回顾性队列研究。由一名对结果和超声报告不知情的研究人员根据国家指南从存档图像中测量宫颈长度。胎盘植入的诊断基于组织学确认。为研究目的，早产定义为孕周小于36周，宫颈长度3厘米或更短被视为宫颈短。采用标准统计分析方法。
共有125例患者符合纳入标准。该队列分为有胎盘植入组（n = 43 [34%]）和无胎盘植入组（n = 82 [66%]），并按超声检查时的孕周分层。胎盘植入妇女在32至34周超声检查时宫颈长度测量值较短（均值±标准差，3.23±0.98对3.95±1.0厘米；P <.01），且更有可能宫颈短至3厘米或更短（P = 0.001）。然而，这些发现与浸润程度无关（P = 0.3），也与导致36周前早产的阴道出血和早产发生率较高无关（P = 0.19）（P = 0.64）。
胎盘植入妇女在32至34周时宫颈长度比低置胎盘或前置胎盘未粘连妇女短，但这一发现与导致36周前早产的阴道出血或早产风险较高无关。
