Evaluating Cervical Length in Placenta Accreta Spectrum and Its Effects on Maternal and Fetal Outcomes: A Prospective Cohort Study.

BACKGROUND: Placenta accreta spectrum (PAS) has high maternal morbidity and poor neonatal outcomes, although the best time for delivery is not clear. Cervical length (CL) may serve as a useful adjunct for risk stratification and individualized delivery planning in PAS pregnancies. OBJECTIVE: To examine the association of serial cervical length measurement with delivery timing and maternal and neonatal outcomes in women with PAS. METHODS: In this prospective cohort study at three university hospitals in Tehran, 41 pregnant women antenatally diagnosed with PAS had transvaginal sonographic CL measurements performed at 28, 32, and 34 weeks' gestation. The main outcome was gestational age at delivery and its connection with the CL. Maternal complications and neonatal morbidity constituted secondary outcomes. RESULTS: Short CL (< 25 mm) at 28 and 32 weeks was significantly related to delivery at ≤ 34 weeks (p < 0.05) and increased Cesarean hysterectomy rates (p = 0.002 at 32 weeks; p = 0.005 at 34 weeks). Emergent Cesarean delivery was more common among PAS patients with CL < 25 mm at 32 and 34 weeks (p = 0.02). Neonates from mothers with short CL had increased likelihood for antibiotics, surfactant, resuscitation, and intubation (all p < 0.05). No significant relations were seen for CL and intraoperative bladder damage or estimated blood loss. CONCLUSIONS: Cervical shortening in the late second and early third trimester in PAS women is significantly associated with earlier term delivery, increased risk of Cesarean hysterectomy, and neonatal morbidity for PAS pregnancies. Repeated assessments of CL may be a useful adjunct for individualizing delivery timing and optimizing maternal-fetal outcomes. Larger prospective multicenter trials are essential to validate the role of CL in risk stratification and to integrate it into an individualized delivery planning algorithm.