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PubMed1989

Placenta praevia--a review with emphasis on the role of ultrasound.

Considerable confusion exists in the literature as a result of the wide range of classification systems for placenta praevia (PP) and low-lying placenta. The discrepancy between frequency of low-lying placentas in the second trimester and PP at term reflects to a certain extent the lack of understanding of the anatomy and physiology of the pregnant uterus. It seems that 'placental conversion' is a real phenomenon and is probably due to the differential growth rates of the placenta and uterus. Maternal bladder overdistension and myometrial contractions account for only a small part of the discrepancy. Diagnostic ultrasound obviously has an important role in placental localization. The role of Magnetic Resonance Imaging remains to be determined. The management of patients with low-lying placenta diagnosed in the second trimester, and the frequency of repeat scans is determined largely by the management protocol of the attending obstetrician.

Female↗
PubMed1993

Placenta praevia: does uterine activity cause bleeding?

Twenty-two women > 24 weeks' gestation with a central placenta praevia were monitored to determine if an increase in uterine activity precedes bleeding in patients with central praevias. Monitoring of all subjects began at 26.3 +/- 4.4 weeks and continued until 37 weeks (or delivery if preterm). All subjects had at least one haemorrhage, 7 women had 2, and 4 subjects had 3 episodes of bleeding. Only 3 patients delivered at term while the remainder (86%) delivered preterm. The gestational age at first episode of bleeding was 29.1 +/- 3.6 weeks and at delivery was 34.3 +/- 3.3 weeks. Nine women (41%) had an increase in uterine activity above baseline the day or the day preceding the first haemorrhage. The increase in uterine activity was not statistically significant when compared to the 6 days prior to bleeding when all 22 patients were considered.

Adult↗
PubMed2003

[Placenta praevia percreta--a serious complication after previous cesarean section].

A 36-year-old G4P1 presented at 20 weeks gestation with vaginal bleeding. Her obstetrical history was significant for two first-trimester spontaneous abortions requiring curettage and a cesarean section. On admission placenta praevia was suspected by ultrasound. A placenta percreta was suspected by ultrasound follow-up at 30 weeks. At 33 weeks she underwent cesarean section because of serious vaginal bleeding. The profound blood loss with consecutive coagulopathy required an emergency hysterectomy and multiple blood transfusions. Placenta percreta is a rare but dramatic complication after previous cesarean section. This should be kept in mind as the rate of elective cesarean sections is rising continuously.

Abortion, Spontaneous↗
PubMedDate not supplied

[Uterine rupture after twenty-two weeks of amenorrhea due to placenta praevia percreta. A case report].

The authors report a case of rupture of the uterus 22 weeks after the LMP, due to placenta praevia percreta and requiring emergency hysterectomy to arrest bleeding, followed by urinary complications. With the predisposing factors of the scars of 4 previous cesarean sections and the low anterior insertion of the placenta, this exceptional case--in terms of its rarity and gravity--led the authors to undertake a review of the literature seeking other cases of this greatly feared obstetric complication. They review the clinical, ultrasonographic (notably the use of color Doppler) and paraclinical (MRI, cystoscopy) diagnostic approach necessary to make an accurate diagnosis of placenta percreta (if possible before any hemorrhagic complications). This situation virtually invariably requires hysterectomy to arrest bleeding, under very difficult conditions because of the massive hemorrhage involved. Mortality remains high and morbidity principally concerns the urinary complications frequently encountered.

Adult↗
PubMed1979

Placenta praevia: significance in the second trimester.

A prospective study was performed on 98 patients to determine the risk of a second trimester placenta praevia remaining until term. The presence and degree of anterior or posterior praevia were scored for each patient. Follow-up data were obtained at delivery on 58 patients. A greater fraction (63.8%) of second trimester praevia was implanted posteriorly. The overall incidence of a second trimester praevia persisting until term was 8.8%.

Female↗
PubMed1983

The management of antepartum haemorrhage (excluding placenta praevia).

A 3-year retrospective survey of patients presenting with an antepartum haemorrhage (APH) to The Royal Women's Hospital, Melbourne, was undertaken. Cases of placenta praevia were excluded from the series. The overall perinatal mortality (PNM) was 14.5%. There were 98 patients with accidental haemorrhage (PNM 23.4%) and 101 patients with an APH of unknown aetiology (PNM 6%). Generalized uterine tenderness and tenseness were the most consistent features associated with imminent fetal compromise and it is in this group that an early resort to Caesarean section may be beneficial. The routine use of a clotting profile was found to be of little value, especially in patients with a mild haemorrhage.

Cesarean Section↗
PubMed1979

[Experiences in diagnosis of placenta praevia by ultrasonic B scanning (author's transl)].

In a clinical experiental report the ultrasonic placentography is evaluated as a very reliable method in the diagnosis of pathological insertion and in the differentiation between the low lying placenta and the placenta praevia. In late pregnancy a control examination is required to find a favourable development as a result of the placental migration.

Diagnosis, Differential↗
PubMed1985

[Prophylactic cerclage in placenta praevia?].

In 12 patients a placenta previa was diagnosed sonographically between 17th and 24th gestational week. A prophylactic cerclage was done in all of them between 18th and 24th week. In no case a placenta previa could be proved by ultrasonic controls. Because of the so called migration of the placenta prophylactic measurements are indicated only after the 30th gestational week. A persistent pathological insertion has to be taken into account only at this moment.

Female↗