Short Cervical Length and Marginal Venous Sinus as Predictors for Antepartum Hemorrhage in Cases of Placenta Previa

Background: Obstetric hemorrhage remains as one of the major causes of maternal death in developing coun-tries and is the cause of up to 50% of estimated 500000 maternal deaths that accur. The incidence of placenta pre-via in term is 1 in 200. Antepartum hemorrhage [APH] is defined as bleeding from or in the genital tract occur-ring from 24 week of pregnancy and prior to the birth of the baby. APH complicates 3 – 5% of pregnancies and is the leading cause of perinatal and maternal mortality. The most important causes of APH are placenta praevia and placenta abruption.Aim of the Work: This study aimed to assess the validity of short cervical length and venous sinus at the margin of the placenta as 3rd trimesteric ultrasound findings for prediction of hemorrhage of placenta previa by TVS and color Doppler. Patients and Methods: This cross sectional study was conducted on 60 pregnant women attending Ain ShamsUniversity Maternity Hospital with gestational age ≥ 28 weeks, singleton viable pregnancy and diagnosed placen-ta previa. The term placenta praevia should be used when the placenta lies directly over the internal os. For pregnan-cies at more than 16 weeks of gestation the term low-ly-ing placenta should be used when the placental edge is less than 20 mm from the internal os on transabdominal or transvaginal scanning (TVS).Results: Cases with antepartum hemorrhage non-signifi-cantly had lower cervical length and more frequent venous sinus. There was significant negative correlation between antepartum hemorrhage attacks and cervical length. Cer-vical length had significant low diagnostic performance in predicting antepartum hemorrhage, but had signifi-cant moderate diagnostic performance in predicting two or more antepartum hemorrhage attacks. Cervical length ≤39.0 mm had moderate diagnostic characteristics in pre-dicting antepartum hemorrhage, while venous sinus had low characteristics. Cervical length ≤39.0 mm and venous sinus had high sensitivity and negative pre-dictive value, but low other characteristics. Overall diagnostic characteristics of cervical length ≤39.0 was higher than that of venous sinus. Previous cesarean sections were sig-nificantly higher in cases that underwent hys-terectomy.Conclusion: There is sufficient evidence to show that shortened cervical length is a strong indicator for APH and that ultrasound measurements of the maternal cervix will be-come the preferred method due to reliabilityand objectivity.