[Placenta praevia and premature separation of the placenta].
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Abruptio Placentae↗
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Placenta praevia and male sex at birth: results from a population-based study.
This study examined the relationship between male sex at birth and placenta praevia in 433031 mother/infant dyads (linked by a common institutional code and hospital admission number) in the Canadian province of Quebec, during the fiscal years of 1991/92-1995/96. The male-to-female ratio among pregnancies with and without placenta praevia was calculated and compared. The male-to-female ratio at birth was higher in pregnancies complicated by a placenta praevia (1.19) than in those without it (1.04; P < 0.02). This increased ratio persisted after accounting separately for the potential confounding and/or modifying effects of maternal age, infant birthweight and gestational age by stratified and multiple logistic regression analyses. We conclude that pregnant women with male babies carry a higher risk of placenta praevia.
Birth Weight↗
[Circular suture of the cervix in placenta praevia].
In the accidents of placenta praevia a modified cervixcerclage was used to 25 women during gestation period of 20 to 35 weeks. The circulare suture goes under the bundles of uterine oessels. This inables to escape the lesions of oessels and dystrophy of the cervix uteri. The circulare suture helps to reduce a number of premature labours. The labours were delayed for 23 days and fetal mortality reduced to 10,53%. Cervixcerclage is indicated. Fetal mortality to prevent fetal mortality and to prolonge the pregnancy.
Cervix Uteri↗
Aetiological factors in placenta praevia--a case controlled study.
The obstetric and gynaecological histories of 80 women with proven placenta praevia have been reviewed together with case controls matched for age and parity. There was a significant relation between placenta praevia and previous caesarean section (P less than 0.05), dilatation and curettage (P less than 0.01), spontaneous abortion (P less than 0.05) and evacuation of retained products of conception (P less than 0.05). Repeated uterine instrumentation was associated with increased risk of placenta praevia (P less than 0.001). We were unable to show any influence of previous termination of pregnancy. These findings are consistent with the hypothesis that endometrial/myometrium damage is a significant aetiological factor in low placental implantation.
Abortion, Induced↗
Women with placenta praevia and antepartum haemorrhage have a worse outcome than those who do not bleed before delivery.
We set out to assess the maternal and neonatal outcomes of women with placenta praevia and antepartum haemorrhage (APH) between 1991 and 1997, compared with woman with a diagnosed placenta praevia who did not bleed. The demographic data, maternal and perinatal outcomes of 159 women with antepartum haemorrhage were compared with 93 women without antepartum haemorrhage in a retrospective study. Women with antepartum haemorrhage had the diagnosis of placenta praevia confirmed at an earlier gestation. More women with antepartum haemorrhage received antenatal steroids and tocolytic agents, and had emergency caesarean sections. The majority of women with bleeding had an emergency caesarean section for antepartum haemorrhage and more delivered early because of fetal distress. There were more preterm deliveries in women with antepartum haemorrhage. The mean birth weight was 2.69 kg in the women with antepartum haemorrhage and 3.06 kg in those without. More infants in the bleeding group had a low Apgar score at the first minute, respiratory distress syndrome, and admission to special baby care and neonatal intensive care unit. It is concluded that there is an increased risk of premature delivery in women with antepartum haemorrhage and placenta praevia. Aggressive management, tocolysis and cervical cerclage should be explored further to improve the perinatal outcome. Women without antepartum haemorrhage can be managed on an outpatient basis.
Journal Article↗
Thromboembolism treated with low molecular weight heparin in a pregnancy complicated by major placenta praevia: a case report.
The concurrent problems of bleeding placenta praevia and thromboembolism present a difficult management problem. We present a case of pulmonary embolism successfully treated with low molecular weight heparin in a woman with a major grade placenta praevia, who required emergency operative delivery.
Adult↗
Caesarean section for placenta praevia: a retrospective study of anaesthetic management.
A retrospective survey of anaesthesia for Caesarean section (CS) for placenta praevia was performed, covering the period between January 1, 1984 and December 31, 1998. Three hundred and fifty consecutive cases of placenta praevia were identified. Overall a regional technique was used 60% of the time. Five women had a placenta accreta which required Caesarean hysterectomy: one had general anaesthesia (GA) throughout and four initially received a single-shot spinal injection. Of these latter four cases, two were converted to GA during the hysterectomy and two continued with spinal anaesthesia throughout. Two other women (both GA), suffered postoperative thrombotic episodes (one pulmonary embolus and one cerebral thrombosis) but made full recoveries. Control of blood pressure when using regional anaesthesia (RA), even in the presence of considerable haemorrhage, was not a problem. Statistical regression models indicated that RA was associated with a significantly reduced estimated blood loss and reduced need for blood transfusion. This retrospective survey finds no data to support the much quoted aphorism that RA is contraindicated for CS in the presence of placenta praevia.
Anesthesia, Epidural↗
Risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage: retrospective study.
OBJECTIVE: To identify risk factors for preterm delivery in women with placenta praevia and antepartum haemorrhage. DESIGN: Retrospective study. SETTING: Regional obstetric unit, Hong Kong. SUBJECTS AND METHODS: Women delivered at Princess Margaret Hospital between 1 January 1990 and 31 December 1997. Possible risk factors for preterm delivery among women with placenta praevia and antepartum haemorrhage including onset, pattern, and severity of vaginal bleeding; presence of uterine contractions on admission; and type of placenta were assessed. RESULTS: Three risk factors for preterm delivery were identified from univariate analysis. These included second trimester vaginal bleeding (odds ratio=4.19; 95% confidence interval, 1.29-13.66), the presence of uterine contractions on admission (odds ratio=4.00; 95% confidence interval, 1.57-10.19), and a haemoglobin decrease of more than 20 g/L (odds ratio=3.00; 95% confidence interval, 1.00-9.04). Using the logistic regression model, second trimester vaginal bleeding and the presence of uterine contractions were found to be independent risk factors for delivery before 36 weeks. CONCLUSION: Preterm delivery is increased in women with placenta praevia and antepartum haemorrhage who have second trimester vaginal bleeding or the presence of uterine contractions. This high-risk group may benefit from close in-patient monitoring and more aggressive management.
Adult↗
From low-lying implantation to placenta praevia: a longitudinal ultrasonic assessment.
A study of 895 consecutive pregnant women studied by transabdominal ultrasound scan showed an incidence of 14.6% of low-lying placenta at 12-14 weeks' gestation. Longitudinal follow-up of those with low-lying placenta showed that 85% of them had normally situated placenta at term. However, for those with partial or total placenta praevia at 30 weeks' gestation, 60% and 75%, respectively, persisted as major placenta praevia at term. A total of 45% of those with low-lying placenta at recruitment had threatened abortion while 15.7% had antepartum haemorrhage. The caesarean section rate was as high as 26% among the study population compared with 8.4% among the general population (P < 0.005). It is recommended that all antenatal women should have at least one ultrasound scan in the second or third trimester for placental localisation. Those found to have major placenta praevia in the third trimester should be closely followed-up.
Adult↗
Major placenta praevia should not preclude out-patient management.
OBJECTIVE: To review current management of women with major and minor placenta praevia in view of the recommendations made in the RCOG guideline 2001. To assess whether out-patient care was detrimental to pregnancy outcome. STUDY DESIGN: Retrospective observational study at the Simpson Memorial Maternity Pavilion, Edinburgh (a tertiary referral centre). One hundred and sixty-one women with major and minor placenta praevia between 1994 and 2000 were separated into those who experienced bleeding (antepartum haemorrhage (APH)) and those who had no bleeding during pregnancy (non-APH). Statistical analysis was carried out using SPSS. RESULTS: There were 129 women (80%) in the APH group. Forty-three were out-patients at the time of delivery and 63% had a major degree of praevia. Thirty-two women were in the non-APH group. Sixty-eight were managed as out-patients and 50% had a major degree of praevia. Women with a major degree of praevia were not significantly more likely to experience bleeding. Women with APH were significantly more likely to be delivered early, by emergency caesarean section (C/S), of lower birthweight babies who required neonatal admission than the non-APH group. CONCLUSION: There is a place for out-patient management of women with placenta praevia. Caution is required with increasing number of bleeds but not degree of praevia.
Adult↗
Placenta praevia and intra-uterine growth retardation.
In 297 cases of placenta praevia, intra-uterine growth retardation was noted in 17,5% of the neonates. This indicates the need for careful monitoring of fetal growth and function during the conservative management of placenta praevia.
Adult↗
Imaging techniques to identify morbidly adherent placenta praevia: a prospective study.
The objective of this study was to assess the sensitivity and specificity of Gray scale ultrasonography, magnetic resonance (MRI) and colour flow Doppler imaging in the diagnosis of morbidly adherent placenta praevia. We collected prospectively 30 cases of placenta praevia diagnosed by Gray scale ultrasound, colour flow Doppler and MRI. Delivery by elective caesarean section was carried out at the 38th week, before the onset of labour, unless obstetric complications supervened. Data regarding maternal outcome and newborn status were collected. Three patients had a morbid adherence of the placenta at delivery, two of whom required caesarean hysterectomy, and the other an internal iliac artery ligation. One patient was delivered at 33 weeks' gestation due to uncontrollable bleeding and the remainder were delivered at 38 weeks. All mothers and infants were well at the time of discharge. Colour flow Doppler was shown to be more specific in the diagnosis of the morbidly adherent placenta praevia than MRI. Doppler had a negative predictive value of 95%.
Adult↗
[Fetal growth in pregnancies complicated by placenta praevia].
Intrauterine growth of neonates born from 167 pregnancies complicated with placenta praevia has been analysed. Growth in 22,7% of the total neonates was retarded as compared to fetal age. About half of these newborns died (18 out of 38). The authors draw the attention prematures with retarded growth. The total perinatal mortality amounted to 25,7% (purified percentage: 23,5). The placental coefficient value was consistently higher than the values obtained in normal pregnancies. This may be explained with the disturbed function of the placenta owing to its abnormal adherence. The retarded growth of the fetus seems to play an important role in the still high perinatal mortality rate of neonates born from pregnancies complicated with placenta praevia.
Birth Weight↗
Placenta creta and placenta praevia creta.
The placental bed in placenta creta and placenta praevia creta was studied from pregnancy or immediate postpartum hysterectomy specimens. In all cases placental villi were seen in direct contact with myometrium, the sine qua non of placenta creta, but was focal in some cases. There was no apparent diminution of decidua parietalis or, in cases of focal accreta, of adjacent basalis. In all cases the extravillous trophoblast was mainly uninuclear or binuclear, in contrast to the placental bed syncytial giant cells seen in late normal placentation. There was an apparent proliferation of interstitial trophoblast at the junction of placenta with myometrium, but the density of interstitial trophoblast deeper in the myometrium was lower than it is in normal placentation. An unusual uteroplacental vasculature was seen in which physiological changes were present in large arteries of the radial/arcuate system deep in the myometrium, while there were also spiral arteries more superficially without physiological changes. These findings suggest that in placenta creta there is defective interaction between maternal tissues, particularly decidua, and migratory trophoblast in the early stages of placentation resulting in undue adherence of the placenta or penetration into the uterus coupled with the development of an abnormal uteroplacental circulation.
Arteries↗
Obstructed tilting disc mitral valve prosthesis associated with placenta praevia.
The occurrence of a bleeding placenta praevia in a young woman, with a viable fetus and an acutely obstructed Lillehei-Kaster valve, provided serious difficulties in priorities and decision making. This has prompted an analysis of the problems which others may encounter.
Adult↗
The anaesthetic management of Caesarean section for placenta praevia: a questionnaire survey.
The purpose of this study was to determine current UK anaesthetic practice regarding the use of regional anaesthesia in the management of patients with placenta praevia presenting for Caesarean section. We asked the members of the Obstetric Anaesthetists Association to complete a postal questionnaire in which a range of clinical situations involving varying degrees of placenta praevia were presented. In each case respondents were asked whether they would be willing to use regional anaesthesia. A wide variety of clinical practice was demonstrated. Anaesthetists with two or more obstetric sessions were more willing to use regional anaesthesia for Caesarean section in the presence of placenta praevia in both elective and emergency situations associated with haemorrhage.
Anesthesia, Epidural↗
Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia.
OBJECTIVES: To correlate transvaginal ultrasound findings with mode of delivery in cases of placenta praevia. DESIGN: Cohort study. SETTING: A London Teaching Hospital. METHODS: Retrospective review of all cases of placenta praevia diagnosed by transvaginal ultrasound between February 1997 and March 2002. MAIN OUTCOME MEASURES: Likelihood of vaginal delivery and major obstetric haemorrhage. RESULTS: A total of 121 pregnancies were studied with a mean scan-to-delivery interval of 10.5 days. In the 64 women who laboured, the likelihood of vaginal delivery rose significantly as the placental edge to internal os distance increased. Caesarean section rate was 90% when the placental edge-internal os distance was 0.1 to 2.0 cm, falling to 37% when this measurement was over 2.0 cm (P < 0.00045). CONCLUSION: Trial of vaginal delivery is appropriate in cases with a placental to internal os distance >2 cm. The term "praevia" should be restricted to cases where the placental edge is < or =2 cm from the internal os, as the likelihood of operative delivery and significant postpartum haemorrhage is high. Cases where the placenta is more than 2 cm from the internal os have a greater than 60% chance of vaginal delivery and should be defined as "low lying" in order to reduce the clinician's bias towards operative delivery.
Adult↗
[Anesthetic management of caesarean section in a patient with idiopathic thrombocytopenic purpura and placenta praevia].
A 24-year-old female with idiopathic thrombocytopenic purpura (ITP) and total placenta praevia was scheduled for caesarean section. Anesthetic management during caesarean section with ITP and placenta praevia is critical because of possibility of massive intra- and postpartal bleeding. The patient received prednisolone 30 mg per day for 10 days before surgery. Bleeding time and value of platelet count returned to normal range on the operative day. Hydrocortisone 100 mg and atropine sulfate 0.3 mg were given intravenously just before the start of anesthesia. Anesthesia was induced with thiamylal 4 mg.kg-1 and SCC 1 mg.kg-1 and maintained with N2O-O2-enflurane. A baby girl was delivered after 7 min, and the Apgar score was 9 at 1 min after delivery. Intraoperative bleeding totaled 1,314 ml, but we could avoid total hysterectomy.
Adult↗