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PubMed2006

Comparison of the accuracy of trans-abdominal sonography (TAS) and transperineal sonography (TPS) in the diagnosis of Placenta Praevia.

BACKGROUND: Although the incidence of Placenta Praevia (PP) is low, its association with increased perinatal and maternal morbidity and mortality underscores the imperative of accurate pre-labour diagnosis. OBJECTIVE: To compare through a prospective study, the accuracy, sensitivity and specificity of Trans-Abdominal Sonography (TAS) and Trans-Perineal Sonography (TPS) in the diagnosis of Placenta Praevia and to determine the causes, if any, of avoidable diagnostic errors. METHODS: During the study period from 1999 to 2001, 133 patients were evaluated by TAS and TPS. The age ranged from 19-41 years while the gestational age ranged from 20-weeks to term. All had examination with 3.5 MHz mechanical sector real-time scanner (Siemens high-resolution Sonoline SL-1 ultrasound machine). The accuracy of TAS and TPS in diagnosing PP was then compared with surgical outcome in each patient. RESULTS: Out of the 133 patients diagnosed to have PP early on in pregnancy, 41 (30.8%) had persistent praevia till delivery, while in 92 (69.2%), the placenta converted to a normal location. The diagnosis at delivery confirmed the TPS diagnosis in 40 of 41 cases, while TAS diagnosis was confirmed in 39 of 41. TPS did not predict the delivery diagnosis in 1 patient where it ruled out a PP, TAS did not predict the delivery diagnosis in 2 patients who were believed not to have a clinically significant placenta praevia. In 1 patient TAS suggested PP but delivery diagnosis showed a normal placental implantation. The overall accuracy, specificity and sensitivity for TPS and TAS were 99.3%, 100%, 99.2% and 97.7%, 98.9%, and 95.1% respectively. CONCLUSION: TPS is a safe, accurate and rapid technique, which complement TAS for evaluation of patients with PP. In patients who decline this method however, graded bladder distension, Trendelenburg and traction scanning and determination of the absence of focal uterine contraction, which distorts the lower uterine segment, are techniques, which significantly improve the diagnosis of PP by TAS.

Abdomen↗
PubMed1977

Ultrasonic diagnosis of placenta praevia.

741 women suspected of placenta praevia were submitted to ultrasonic scanning during the second and/or third trimesterr of pregnancy. In 61 an abnormal placental site was diagnosed. During Caesarean section, carried out in 46 of these cases, the location was compared with the ultrasound findings. The scanning diagnosis during the last trimester correlated with the findings at delivery. At scanning after the 35th week the diagnosis differed in only 4 cases. In all 4 there was a question of a low-lying placenta versus partial placenta praevia. During the second trimester diagnosis of low-lying placenta were revised in several cases at later scans. It is discussed whether these early diagnoses of an abnormal placental site, which later becomes normal, indicate a migrating placenta and/or an uncertainty of the scanning method. Early diagnosis of low-lying placentae should be checked by repeat scans.

Cesarean Section↗
PubMed1994

Do women with placenta praevia without antepartum haemorrhage require hospitalization?

Patients with placenta praevia in the third trimester are routinely confined to hospital for fear of major haemorrhage. Whilst this is arguably necessary for those who have had an episode of antepartum haemorrhage (APH), it is uncertain whether these same management principles are valid for those with placenta praevia without antepartum haemorrhage. A retrospective study was undertaken reviewing the case records of 69 consecutive patients diagnosed with placenta praevia in the third trimester of pregnancy. The outcome of 15 who had had no episodes of bleeding were compared with those who had at least 1 antepartum bleeding episode. Patients with placenta praevia without evidence of APH spent a significantly shorter amount of time in hospital and had a significantly lower rate of emergency delivery, with a neonatal outcome as good if not better than the APH group. We conclude that outpatient management in this cohort of patients may be a safe and cost-effective means of care, and warrants randomized prospective study.

Adult↗
PubMed1995

The role of transvaginal sonography in the diagnosis of placenta praevia.

Transvaginal sonography was performed in 70 patients diagnosed to have placenta praevia by transabdominal sonography. The diagnosis was confirmed either by digital examination in theatre at term or operative finding at delivery. Forty-nine cases (70%) were correctly diagnosed to have placenta praevia by both modes of sonography. Transvaginal sonography ruled out placenta praevia in 12 cases (17%) thought to be placenta praevia by transabdominal ultrasound. Both transabdominal and transvaginal sonography demonstrated 'placental migration' in 4 cases (6%) which were no longer praevia at delivery. Five patients (7%) were erroneously believed to have placenta praevia by both sonographic techniques. Overall, the diagnostic accuracy of transvaginal sonography was 92.8% compared with 75.7% for transabdominal sonography. None of the subjects experienced any exacerbation of bleeding or other complications. The results suggest that transvaginal sonographic localization of the placenta is safe and superior to the transabdominal route.

Abdomen↗
PubMed2002

Risk factors for placenta praevia in southern Nigeria.

OBJECTIVE: To determine the risk factors for placenta praevia in Ile-Ife, southern Nigeria. DESIGN: A prospective case control study. SETTING: A tertiary center--Obafemi Awolowo University Teaching Hospital, Ile-Ife, southern Nigeria. SUBJECTS: One hundred and thirty six patients with confirmed placenta praevia constituted the cases. Controls consisted of one hundred and thirty six patients who delivered at term immediately after each indexed case and did not have placenta praevia. RESULTS: Cases and controls were similar in terms of twin deliveries (P = 0.72) and past history of uterine surgery (P = 0.47). After adjusting for confounders, factors associated with risk of placenta praevia were history of retained placenta [OR = 6.7(95% CI 1.2-36.6)], previous caesarean section [OR = 4.7, (95% CI 1.9-11.4)], previous abortion [OR = 2.9 (95% CI 1.1-5.1)], grand multiparity [OR = 2.1 (95% CI 1.6-7.1)] and age over 35 years [OR = 1.4 (95% CI 1.2-6.6)]. CONCLUSIONS: From our study, the risk factors for placenta praevia are a history of retained placenta, previous caesarean section, previous abortion, grand multiparity and maternal age over 35 years.

Abortion, Induced↗
PubMed1980

Placenta praevia without antepartum haemorrhage.

The incidence of placenta praevia praevia in a series in a series of 26,155 patients was 0.9%; in 81 of the 238 patients (34%) there was no antepartum haemorrhage. Placenta praevia was known to be present before delivery in only 12 of the latter group, the condition being diagnosed after vaginal delivery in 17 and at Caesarean section in 52. Approximately 40% of patients with placenta praevia who deliver vaginally have had no antepartum haemorrhage.

Cesarean Section↗
PubMed1986

[Cesarean section for placenta praevia. Perinatal mortality and morbidity].

The severity of placenta praevia is well known and responsible of a non negligible perinatal mortality. This study relates to 65 children born after a cesarean section for placenta praevia and analyzes the fetal complications, their frequency, their prognosis as well as the obstetrical factors connected to this problem. Mortality is 3%, prematurity remains high and so is the anemia, but hypotrophy is rare. The main complications are infection essentially due to an overlapping placenta praevia, its hemorrhagic nature and the increasing number of hemorrhagic episodes and respiratory complications (respiratory distress, inhalation of amniotic fluid and hyaline membrane disease). From these fetal data, the authors propose a method of management of low placental insertions consisting essentially of bed rest as soon as the diagnosis in made on the sonogram, and extraction at the 35th week of amenorrhea. In case of hemorrhage, extraction must be performed earlier if obstetrical conditions, maternal as well as fetal, do not permit to undertake a conservative approach aimed essentially to decrease prematurity and its consequences.

Cesarean Section↗
PubMedDate not supplied

[Methods for diagnosing placenta praevia].

All methods of placenta praevia diagnosis such as: amniography, cystography, arteriography soft X-ray, displacement, isotope technique, thermography, Doppler's technique, and NMR have been surveyed and compared. Historical background of each technique respective modifications, interpretation of the results, complications, contraindications and safety are discussed.

Diagnostic Imaging↗
PubMed2000

Fetal growth and sex related to placenta praevia.

A retrospective study investigating all cases given a diagnosis of placenta praevia at the Birmingham Women's Hospital Trust, January 1993 to June 1997, was undertaken to investigate any neonatal sex or weight differences compared with the general singleton pregnancies. Mothers with placenta praevia were at increased risk of preterm delivery, fetal malpresentation and having a caesarean section as the mode of delivery. No differences were found in the fetal sex ratio or incidence of small for gestational age (SGA) infants and indeed male infants overall were larger for dates in the placenta praevia group when compared with their gestational equivalents in the control population. Although ultrasound assessment of pregnancies complicated by placenta praevia may be useful in checking the resolution of the condition by 'placental migration', there is no indication for its use in monitoring growth restriction.

Journal Article↗
PubMed1986

Placenta praevia and sex ratio at birth.

The ratio of male to female sex among infants born to 391 women with and 114 079 without placenta praevia was analysed by parity. In the women without placenta praevia the sex ratio decreased significantly with increasing parity, whereas in the women with placenta praevia it increased. Overall, the sex ratio was increased among the women with placenta praevia, particularly multiparas. An increase in the sex ratio at birth is associated with insemination early or late in the menstrual cycle, which may result in delayed development and implantation of the blastocyst; this may be a predisposing factor in placenta praevia.

Female↗
PubMed1996

Pregnancies complicated by placenta praevia: what is appropriate management?

OBJECTIVE: To review the outcome of pregnancies complicated by placenta praevia over a three-year period (1991-1993) and to describe in detail the antenatal course and the events leading to delivery, assessing retrospectively whether there are clinical features predictive of outcome and whether outpatient management would be reasonable. DESIGN: A retrospective review of the case records of women with a pregnancy complicated by placenta praevia. SETTING: A tertiary referral teaching hospital in Edinburgh. RESULTS: There were 15,930 deliveries in the study period. Fifty-eight women (0.4%) had a placenta praevia in the third trimester, 42 of whom (72%) had at least one episode of bleeding. Overall, 62% of the women had a major praevia with no differences in the grade of praevia between those women who did or did not have bleeding. Both diagnosis and delivery occurred significantly earlier in women with antepartum bleeding than in those without (median gestation at diagnosis 28.6 weeks versus 33.3 weeks (P < 0.01) and at delivery 36.0 weeks versus 37.1 weeks (P = 0.04), respectively). Delivery by emergency caesarean section was more common in women with bleeding (62% versus 38%). An increasing number of bleeding episodes experienced by individuals was not associated with significant differences in outcomes. Rapid emergency delivery for bleeding was necessary for three women, in none of whom could the bleeding have been predicted. CONCLUSIONS: The clinical outcomes of placenta praevia are highly variable and cannot be predicted confidently from antenatal events. Nonetheless, in the majority of cases with or without bleeding and irrespective of the degree of praevia, outpatient management would appear safe and appropriate.

Ambulatory Care↗
PubMed1999

Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia.

This randomised prospective study was designed to evaluate the use of transvaginal (TVS) and transabdominal (TAS) ultrasound in the diagnosis of placenta praevia and its effect on length of stay in hospital. One hundred and thirty patients with antepartum haemorrhage (APH) and/or malpresentation with a suspicion of placenta praevia were referred to the scanning department of Aberdeen Maternity Hospital and Princess Badee'a Teaching Hospital from July 1993 to December 1996. Fifty-eight patients had an ultrasound because of antepartum haemorrhage and 72 had a malpresentation and/or unstable lie. All examinations were performed by the same authors. Placenta praevia was diagnosed in 13 (22.4%) out of 58 cases presenting with APH and in five (7%) out of 72 cases presenting with malpresentation. There was a high false positive rate in the detection rate of placenta praevia using TAS (23%) compared with TVS (11.5%) which is higher than other reported figures (2-6%). The mean length of stay in hospital of the group in whom the results were released was 9.2 days compared with those not released where it was 15.7 days. The difference was significant (P <0.05). This study suggests that the traditional transabdominal approach to the diagnosis of placenta praevia can be improved upon. TVS is a safe method and with improved accuracy over TAS can reduce the length of stay in hospital.

Clinical Trial↗
PubMed2006

Placenta praevia--comparison of four sonographic modalities.

AIM: The aim of this study was the evaluation of four ultrasound modalities (transabdominal, perineal, transvaginal and transrectal) to examine placenta praevia or low lying placenta. METHOD: We prospectively investigated 24 patients after 25 weeks of their pregnancy with suspected placenta praevia or low lying placenta. We analysed picture quality and compared the results of all four scanning modalities with the actual diagnosis made at delivery. RESULTS: The abdominal and perineal approach provided significantly poorer scanning quality (good or moderate in 79/38 %) as compared to the transvaginal and transrectal approach (good or moderate in 83/97 %). We can state similar results concerning accuracy of the diagnosis (abdominal/perineal 42/21 %, transvaginal/transrectal 67/86 %). DISCUSSION: Our study supports the diagnostic superiority of transvaginal ultrasound in the diagnosis of placenta praevia in comparison to the abdominal/perineal view. We also show that transrectal scanning is at least equivalent in quality and safety without the imminent risks of transvaginal manipulation and infection. CONCLUSION: The evaluation of the transrectal approach proved equivalent to the standard transvaginal approach in depiction quality and diagnostic safety. Thus, with less potential trauma to the pregnancy, it is a reasonable alternative.

Female↗
PubMed2005

Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section.

Fourteen women with placenta praevia (including one who also had placenta accreta) undergoing caesarean section had massive bleeding after removal of the placenta. In order to preserve the uterus, two parallel vertical compression sutures were placed in the lower segment to compress the anterior and posterior walls of the lower uterine segment. The haemorrhage from the lower segment stopped immediately after the knots were tightened. All women later resumed normal menstrual flow with no apparent complications. Two of the 14 women had a spontaneous pregnancy one to two years after the operation. This parallel vertical compression suturing technique is simple, easy and effective for controlling bleeding in women with placenta praevia or accreta. We suggest that this technique be tried first before other more complex procedures are undertaken.

Adult↗
PubMed1992

[The course of pregnancy with placenta praevia diagnosed in the 2nd and 3rd trimester].

Selected clinical features of the course of pregnancy in 118 gravidas with placenta praevia diagnosed ultrasonographically on the first breeding were compared. The clinical features significantly connected with bleeding and the prognostic features for the way of delivery were stated. The longest bleeding was observed in patients with partial or marginal placenta praevia. The most common anterior location of low placenta praevia was connected with the lowest risk as regards the cesarean section due to hemorrhage. The earlier occurrence of the bleeding was associated with its longer duration. The time of the occurrence of the first bleeding and its duration were associated with a duration of the pregnancy and a body mass of the newborn. The recurrence of bleeding was of no prognostic importance. The appearance of the first bleeding after the 28th week of pregnancy was significantly connected with the necessity of performing a cesarean section due to hemorrhage in case of central, partial or marginal placenta praevia. In case of low-lying placenta the way on delivery was significantly related to the time of appearance of the first bleeding and the distance between the placenta and the internal os. Fisher's linear discriminative function of the two features allowed for the determination of a mathematical formula for the prognosis of the way of delivery in case of a low-lying placenta.

Adolescent↗
PubMed2006

Management of women with major placenta praevia without haemorrhage: a questionnaire-based survey of Irish obstetricians.

Our aim was to determine individual management of women with major placenta praevia without antepartum haemorrhage (APH) using a questionnaire-based study. Placenta praevia complicates one in 200 pregnancies. It is associated with maternal mortality of 0.03%. The maternal, fetal and neonatal morbidity and mortality are due to the complications of haemorrhage and prematurity. APH due to placenta praevia is unpredictable and this may explain the traditional inpatient approach to management. This approach may be justified in those with bleeding, it is questionable in those who have not bled. A total of 121 obstetricians replied (63%), to 192 questionnaires sent out. Of these, 48 obstetricians would admit all women with major placenta praevia without APH, while 69 would manage them on an outpatient basis. When asked whether or not they agreed with outpatient management, 21 agreed strongly, 51 tended to agree, 23 tended to disagree and 13 disagreed strongly. Over half of the obstetricians adopt an outpatient management approach.

Attitude of Health Personnel↗
PubMed1982

[Results of conservative and surgical treatment for placenta praevia (author's transl)].

Modified cervix cerclage was applied to 75 women with placenta praevia, between the 16th and 36th weeks of pregnancy. Results obtained from conservative treatment of patients for placenta praevia are compared with those obtained from surgical treatment. Pregnancy was extended 38.4 days on average by cervix cerclage. Complaints were removed by surgery from 50.6 per cent of the patients who were dismissed from hospital. They showed neither bleeding nor any sings of imminent premature birth. Perinatal mortality went down to 6.45 per cent. Average extension of pregnancy by conservative treatment was 12.8 days. Only 7.3 per cent of the patients could be dismissed from hospital. Perinatal mortality went up to the order of 19.1 per cent. These data are interpreted as providing evidence to the advantage of surgical treatment of placenta praevia, as perinatal mortality is reduced.

Female↗