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At least 19 recordsLinked to original sources
PubMed2006

Placenta previa, placenta accreta, and vasa previa.

Placenta previa, placenta accreta, and vasa previa are important causes of bleeding in the second half of pregnancy and in labor. Risk factors for placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. The diagnostic modality of choice for placenta previa is transvaginal ultrasonography, and women with a complete placenta previa should be delivered by cesarean. Small studies suggest that, when the placenta to cervical os distance is greater than 2 cm, women may safely have a vaginal delivery. Regional anesthesia for cesarean delivery in women with placenta previa is safe. Delivery should take place at an institution with adequate blood banking facilities. The incidence of placenta accreta is rising, primarily because of the rise in cesarean delivery rates. This condition can be associated with massive blood loss at delivery. Prenatal diagnosis by imaging, followed by planning of peripartum management by a multidisciplinary team, may help reduce morbidity and mortality. Women known to have placenta accreta should be delivered by cesarean, and no attempt should be made to separate the placenta at the time of delivery. The majority of women with significant degrees of placenta accreta will require a hysterectomy. Although successful conservative management has been described, there are currently insufficient data to recommend this approach to management routinely. Vasa previa carries a risk of fetal exsanguination and death when the membranes rupture. The condition can be diagnosed prenatally by ultrasound examination. Good outcomes depend on prenatal diagnosis and cesarean delivery before the membranes rupture.

Balloon Occlusion↗
PubMed1992

Placenta previa.

Placenta previa occurs in approximately one in 200 pregnancies. The cause is unknown, but endometrial damage due to prior pregnancy, cesarean section, and other factors predispose to it. Diagnosis is usually made by transabdominal ultrasonography. False-positive diagnoses are common in the second trimester and the term "potential placenta previa" has been proposed to describe this situation. Bleeding with placenta previa is usually associated with uterine contractions, thus the introduction of tocolysis. Placenta accreta is common in the patient with one or more previous cesarean sections and placenta previa in the current pregnancy. Management of placenta previa is expectant and involves avoidance of digital vaginal examination, delay of delivery until 36 weeks' gestation and/or documented fetal lung maturity, transfusion support to maintain maternal hematocrit greater than or equal to 30%, serial ultrasonography, antepartum fetal heart rate monitoring, glucocorticoids, tocolytic therapy, and elective delivery by cesarean section. Maternal mortality is rare with placenta previa. Perinatal mortality is currently 4% to 8% primarily related to complications of prematurity.

Amniocentesis↗
PubMed1990

[Continuous ultrasonic observation on the change of location of placenta in placenta previa].

Placenta previa was studied in 50 cases during 20-28 weeks of gestation by ultrasonic scanning. The change of location of placenta was monitored continuously for these cases. The rates of change of location to normal sites were 90% for low-lying placenta, 65% for marginal implantation, 13% for partial placenta previa and 11% for central placenta previa. It is suggested that partial or central placenta previa observed during mid-trimester should be categorized as a high risk state.

Female↗
PubMed1997

Clinical risk factors for placenta previa-placenta accreta.

OBJECTIVE: Our purpose was to define the clinical risk factors associated with placenta previa-placenta accreta. STUDY DESIGN: Hospital records were reviewed of all cases of placenta accreta confirmed histologically between January 1985 and December 1994. Additionally, we reviewed the records of all women with placenta previa and all those undergoing cesarean hysterectomy during the same period. Multiple logistic regression analysis was used to identify independent clinical risk factors for placenta accreta. RESULTS: Among 155,670 deliveries, 62 (1/2510) were complicated by histologically confirmed placenta accreta. Placenta accreta occurred in 55 of 590 (9.3%) women with placenta previa and in 7 of 155,080 (1/22,154) without placenta previa (relative risk 2065, 95% confidence interval 944 to 4516, p < 0.0001). Among women with placenta previa, advanced maternal age (> or = 35 years) and previous cesarean delivery were independent risk factors for placenta accreta. Placenta accreta was present in 36 of 124 (29%) cases in which the placenta was implanted over the uterine scar and in 4 of 62 (6.5%) cases in which it was not (relative risk 4.5, 95% confidence interval 1.68 to 12.07). Among women with placenta previa, the risk of placenta accreta ranged from 2% in women < 35 years old with no previous cesarean deliveries to almost 39% in women with two or more previous cesarean deliveries and an anterior or central placenta previa. CONCLUSION: Placenta accreta occurs in approximately 1 of 2500 deliveries. Among women with placenta previa, the incidence is nearly 10%. In this high-risk group advanced maternal age and previous cesarean section are independent risk factors.

Adult↗
PubMed1998

Risk factors and morbidity in patients with placenta previa accreta compared to placenta previa non-accreta.

BACKGROUND: Placenta accreta is associated with high morbidity and most cases occur with placenta previa. This study was carried out in an attempt to define risk factors for placenta accreta in cases of placenta previa and to quantify the increased morbidity of placenta previa accreta in comparison to placenta previa alone. METHODS: The records of all patients delivered by cesarean section (CS) for placenta previa and accreta during the seven-year period from 1990 to 1996, inclusive, were reviewed. Data regarding the demographic features, previous CS, the incidence of hysterectomy and postpartum morbidity were analyzed. RESULTS: Out of 23070 deliveries 110 (0.48%) had placenta previa, twelve (0.05%) of whom had placenta previa accreta. There was no significant difference in age and parity. Patients with a history of previous CS showed a significant increase in the incidence of placenta previa accreta (p=0.001). The percentage of accreta increased linearly from 4.1% in patients with no CS to 60% in patients who had had three or more CS. Postpartum hemorrhage and emergency hysterectomy were significantly higher among the previa accreta patients compared with the previa patients alone (p<0.001; p<0.001, respectively). CONCLUSION: In the presence of a previous history of CS, patients with antepartum diagnosis of placenta previa are considered to be at a greater risk for having placenta accreta. The risk increases with the increase in the number of previous CS. Patients with placenta previa accreta have a significantly higher incidence of PPH and are more likely to undergo emergency hysterectomy.

Adolescent↗
PubMed1983

Rh immunoglobulin use with placenta previa and abruptio placentae.

Patients with obstetric hemorrhage from placenta previa or abruptio placentae may be at increased risk of Rh sensitization because they fail to receive Rh immunoglobulin (RhIG) or are given an inadequate dose. To evaluate the use of RhIG in this clinical situation, we studied 498 patients with hemorrhage from placenta previa or abruptio placentae treated at a large municipal hospital from 1975 to 1979. All 25 RhIG candidates received the product before their discharge from the hospital. This rate of RhIG use was equal to that for patients whose infants were delivered without these complications and significantly higher than that for patients with spontaneous abortion and ectopic pregnancy at the same hospital (P less than .05). Prompt administration of an adequate dose of RhIG to candidates with bleeding from placenta previa or abruptio placentae can further reduce Rh hemolytic disease.

Abortion, Spontaneous↗
PubMed1996

The association of cigarette smoking with placenta previa and abruptio placentae.

Smoking was recognized as having an adverse effect of pregnancy outcome as early as the mid 1950s. Smoking is a well recognized risk factor for low birthweight infants and has been implicated in preterm birth. The increased risk of both placenta previa and abruptio placentae among women who continue to smoke during pregnancy, is in general, less well recognized, but supported by numerous studies. The purpose of this article is to review the published literature dealing with the risk of placenta previa and abruptio placentae in women who smoke during their pregnancy.

Abruptio Placentae↗