title: Shorter the cervix, more difficult the placenta percreta operations.
abstract: BACKGROUND
  To determine the impact of cervical length (CL) on the clinical outcome of patients undergoing peripartum hysterectomy due to placenta previa/percreta.
  
  
  OBJECTIVE
  To assess the association of CL with clinical outcomes in such patients.
  
  
  METHODS
  We analyzed the data of patients who were diagnosed with anterior placenta previa/percreta prenatally and subsequently underwent peripartum hysterectomy at our tertiary care institution between 2004 and 2014. The sonographic images and measurements of CL were obtained from prospectively collected database. The duration of operation, units of blood products transfused, and length of stay in the hospital were recorded. Patients were stratified according to CL, and receiver-operating characteristics curves were used to determine the cut-off length for identification of patients at high risk of intra-operative difficulty.
  
  
  RESULTS
  Sixty-one patients were included in this study. Number of packages of ES were correlated with the the duration of operation (r = 0.666, p < 0.001) and the CL (-0.793, p < 0.001). Number of packages of fresh frozen plasma was significantly correlated with the CL (-0.642, p < 0.001) and the duration of operation (r = 0.606, p < 0.001). Gestational age (AUC = 0.683, p = 0.014) and the CL (AUC = 0.980, p < 0.014) were significant predictors for the number of ES transfused > 4 packages. The cut-off value of four packages was determined according to the median level of packages transfused. Optimal cut-off value for the CL to predict transfusion ≤ 4 packages was 20.5 with 93% sensitivity and the 99% specificity.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology , Zeynep Kamil Women Health Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Mesut
authors.initials: M
authors.lastname: Polat
authors.affiliation: b Department of Obstetrics and Gynecology, Division of Gynecologic Oncology , Istanbul University Cerrahpasa School of Medicine , Istanbul , Turkey.
authors.forename: Ilker
authors.initials: I
authors.lastname: Kahramanoglu
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology , Zeynep Kamil Women Health Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Taylan
authors.initials: T
authors.lastname: Senol
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology , Zeynep Kamil Women Health Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Enis
authors.initials: E
authors.lastname: Ozkaya
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Gynecologic Oncology , Zeynep Kamil Women Health Training and Research Hospital , Istanbul , Turkey and.
authors.forename: Ates
authors.initials: A
authors.lastname: Karateke
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000706:statistics & numerical data; D054791:Cervical Length Measurement; D002585:Cesarean Section; D005260:Female; D005865:Gestational Age; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D061646:Operative Time; D010921:Placenta Accreta / Q000601:surgery*; D010949:Plasma; D011247:Pregnancy
keywords: Accreta; cervical length measurement; cervix; cesarean section; hemorrhage; hysterectomy; percreta; placenta accreta