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April 18, 2026BMC Pregnancy and Childbirth1 citationsOpen Access

Cervical length and maternal and neonatal outcomes in placenta accreta spectrum: a single-center cohort study from Shiraz, Iran (2020–2024)

MKMaryam KasraeianSAShaghayegh Moradi AlamdarlooNANasrin Asadi

Key Result

In women with placenta accreta spectrum, a short cervical length (<25 mm) was not significantly associated with massive hemorrhage compared to a cervical length ≥25 mm.

Key Points

  • This study evaluates how cervical length affects maternal and neonatal outcomes in women with placenta accreta spectrum.
  • Retrospective cohort study design conducted at Shiraz University hospitals
  • Transvaginal sonography used to measure cervical length
  • Collected demographic and obstetric history data
  • Analyzed maternal outcomes like bleeding and ICU admission
  • Assessed neonatal outcomes including birth weight and NICU stay
  • Shorter cervical length linked to longer preoperative hospital stays (median 10.5 vs. 4 days)
  • No significant difference in massive hemorrhage or emergency surgery between groups
  • Neonates from mothers with CL < 25 mm had longer NICU stays (19 vs. 13 days)
  • Cervical length not significantly associated with massive hemorrhage or neonatal mortality

Study Design

Type

Cohort (n=140)

Multicenter

No

Structured PICO

Does a short cervical length (<25 mm) predict adverse maternal and neonatal outcomes in women with placenta accreta spectrum?

P
Population
140 pregnant women with a definitive diagnosis of placenta accreta spectrum (PAS), mean age 35.05 years, from a single center in Shiraz, Iran.
I
Intervention
Short cervical length (CL < 25 mm) measured by transvaginal sonography
C
Comparator
Normal cervical length (CL ≥ 25 mm)
O
Outcome
Maternal outcomes (massive hemorrhage >2000 mL, emergency surgery, intraoperative complications, ICU admission) and neonatal outcomes (NICU admission, mortality, length of stay)

In women with placenta accreta spectrum, a short cervical length (<25 mm) is not an independent predictor of massive hemorrhage but is associated with more invasive placental phenotypes, longer antepartum hospitalization, and prolonged neonatal NICU stays.

Main Result

Absolute Event Rate: 40.9% vs 38.5%

p-value: p=0.790

Limitations

  • Single-center retrospective design
  • Potential confounding by disease severity

Abstract

A short cervical length (CL) in placenta accreta spectrum (PAS) may be associated with adverse outcomes. This study aimed to evaluate the impact of CL on maternal and neonatal outcomes in PAS. This retrospective cohort study was conducted at hospitals affiliated with Shiraz University of Medical Sciences from January 2020 to December 2024. Transvaginal sonography was used to measure in women with PAS. Collected data included demographics, obstetric history, and maternal outcomes (e.g., bleeding volume, complications, ICU admission). Neonatal outcomes included gestational age, birth weight, Apgar scores, NICU admission, and mortality. Statistical analysis was performed using SPSS, employing chi-squared tests, logistic regression, and comparative analyses, with p 2000 mL, 40.9% vs. 38.5%, p = 0.790), emergency surgery (36.1% vs. 48.8%, p = 0.203), or intraoperative complications (25.6% vs. 29.2%, p = 0.664). Cervical length was not significantly associated with massive hemorrhage in univariate logistic regression analysis (OR 0.94, 95% CI 0.92–1.03, p = 0.378). Neonatal mortality and fetal demise were not significantly different(p = 0.672,0.372 respectively). However, neonates of mothers with CL < 25 mm had a longer median NICU stay (19 vs. 13 days, p = 0.012). In PAS, a short cervical length was not independently associated with massive hemorrhage but was linked to prolonged antepartum hospitalization and longer neonatal NICU stays. Adverse neonatal outcomes appear mediated by prematurity. CL assessment, combined with bleeding history, may aid in risk stratification and timing of delivery to improve outcomes.

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Cite This Study

Kasraeian et al. (2026) conducted a cohort in Placenta accreta spectrum (n=140). Cervical length <25 mm vs. Cervical length ≥25 mm was evaluated on Massive hemorrhage (>2000 mL) (p=0.790). In women with placenta accreta spectrum, a short cervical length (<25 mm) was not significantly associated with massive hemorrhage compared to a cervical length ≥25 mm.

synapsesocial.com/papers/69e31f1a40886becb653e874https://doi.org/10.1186/s12884-026-09021-4
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Also Consider

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