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

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 < 0.05 considered significant. Among 140 women, 44 had a CL < 25 mm and 96 had a CL ≥ 25 mm. A shorter CL was associated with a longer preoperative hospital stay (median 10.5 vs. 4 days, p = 0.034). There were no significant differences in massive hemorrhage (> 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.