| 2. AUTHOR | Farine-D,
Peisner-D-B, Timor-Tritsch-I-E. |
| INSTITUTION | Department
of Obstetrics and Gynecology, Mt. Sinai Hospital, Toronto, Ontario, Canada. |
| TITLE | Placenta
previa--is the traditional diagnostic approach satisfactory? |
| SOURCE | J-Clin-Ultrasound
1990 May, VOL: 18 (4), P: 328-30, ISSN: 0091-2751. |
| ABSTRACT | The
accuracy of the diagnosis of placenta previa using transvaginal sonography (TVS)
was compared to that of the traditional transabdominal sonography (TAS). Seventy
seven women were scanned by both methods and each sonographic diagnosis was compared
to the placental location at delivery. TVS was superior to TAS in diagnosing placenta
previa and invariably correct in ruling it out. TVS (and TAS) failed to predict
the placental location at delivery only in women diagnosed as having marginal
placenta previa prior to 35 weeks gestation. The use of the vaginal probe significantly
improved the accuracy of the diagnosis of placenta previa. Author. |
| 3. AUTHOR | Tan-N-H,
Abu-M, Woo-J-L, Tahir-H-M. |
| INSTITUTION | Department
of Obstetrics and Gynaecology, Faculty of Medicine, National University of Malaysia,
Kuala Lumpur. |
| TITLE | The
role of transvaginal sonography in the diagnosis of placenta praevia. |
| SOURCE | Aust-N-Z-J-Obstet-Gynaecol
1995 Feb, VOL: 35 (1), P: 42-5, ISSN: 0004-8666. |
| ABSTRACT | 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. Author. |
| 4. AUTHOR | Mabie-W-C.
|
| INSTITUTION | Department
of Obstetrics and Gynecology, University of Tennessee, Memphis. |
| TITLE | Placenta
previa. |
| SOURCE | Clin-Perinatol
1992 Jun, VOL: 19 (2), P: 425-35, ISSN: 0095-5108 43 Refs. |
| ABSTRACT | 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. Author. 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. Author. |
| 5. AUTHOR | Love-C-D,
Wallace-E-M. |
| INSTITUTION | Simpson
Memorial Maternity Pavilion, Edinburgh. |
| TITLE | Pregnancies
complicated by placenta praevia: what is appropriate management? |
| SOURCE | Br-J-Obstet-Gynaecol
1996 Sep, VOL: 103 (9), P: 864-7, ISSN: 0306-5456. |
| ABSTRACT | |
| 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. |
| CONCLUSION | 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. Author. |
| 6. AUTHOR | Wing-D-A,
Paul-R-H, Millar-L-K. |
| INSTITUTION | Department
of Obstetrics-Gynecology, University of Southern California School of Medicine,
Los Angeles 90033, USA. |
| TITLE | Management
of the symptomatic placenta previa: a randomized, controlled trial of inpatient
versus outpatient expectant management. |
| SOURCE | Am-J-Obstet-Gynecol
1996 Oct, VOL: 175 (4 Pt 1), P: 806-11, ISSN: 0002-9378. |
| ABSTRACT | |
| OBJECTIVE | Our
purpose was to determine the safety, efficacy, and costs of inpatient and outpatient
management of symptomatic placenta previa. |
| STUDY
DESIGN | Fifty-three
women with the initial diagnosis of placenta previa at 24 to 36 weeks' gestation
who required hospitalization for vaginal bleeding were stabilized and then randomized
to receive either inpatient or outpatient expectant management. Twenty-seven inpatients
were placed at bed rest with minimal ambulation, received weekly corticosteroids
until 32 weeks of gestation, and underwent ultrasonographic examination at 2-week
intervals to assess fetal growth and placental location. Twenty-six outpatients
were discharged home after > or = 72 hours of hospitalization. Each week they
also received corticosteroids, until 32 weeks' gestation, and ultrasonographic
evaluations. Outpatients with recurrent bleeding were readmitted for evaluation.
All subjects who reached 36 weeks' gestation with persistent placenta previa underwent
amniocentesis. When fetal lung maturity was present, cesarean delivery was electively
performed. |
| RESULTS | There
were insignificant differences between inpatients and outpatients for mean age,
parity, race, type of previa (complete or partial), number of prior vaginal bleeding
episodes, and initial hemoglobin value. The mean estimated gestational age at
enrollment was 29.1 +/- 3.1 (SD) weeks for inpatients and 29.9 +/- 3.1 weeks for
outpatients. In eight patients the placenta was found to no longer cover the internal
os by 36 weeks' gestation. There were seven patients in each group who did not
complete the protocol for initial treatment assignment. The average estimated
gestational age at delivery for the inpatients was 34.5 +/- 2.4 weeks and 34.6
+/- 2.3 weeks for the outpatients (p = 0.90), whereas the mean birth weights were
2413.7 +/- 642.7 gm and 2607.8 +/- 587.1 gm, respectively (p = 0.28). Thirty-three
patients (62.3%) had recurrent episodes of bleeding, with 26 requiring expeditious
cesarean delivery. Four (14.8%) inpatients and one (3.7%) outpatient required
blood transfusion (p = 0.67). There was no difference in neonatal morbidity (defined
as the presence of respiratory distress syndrome, intracranial hemorrhage, or
culture- proved sepsis) between the two groups (relative risk 1.16, 95% confidence
interval 0.66 to 2.02). There were no neonatal deaths. The mean number of maternal
hospital days differed significantly between the two groups: inpatients required
an average of 28.6 +/- 20.3 days and outpatients remained hospitalized for an
average of 10.1 +/- 8.5 days (p <0.0001). Cost analysis based on maternal hospital
days reveals a net savings of +15,080 per patient if women with symptomatic placenta
previa initially diagnosed before 37 weeks' gestation are treated as outpatients.
|
| CONCLUSION | For
selected patients, outpatient management of symptomatic placenta previa appears
to be an acceptable alternative to traditional conservative expectant inpatient
management. Author. |
| 7. AUTHOR | Droste-S,
Keil-K. |
| INSTITUTION | Department
of Obstetrics and Gynecology, University of Wisconsin-Madison. |
| TITLE | Expectant
management of placenta previa: cost-benefit analysis of outpatient treatment. |
| SOURCE | Am-J-Obstet-Gynecol
1994 May, VOL: 170 (5 Pt 1), P: 1254-7, ISSN: 0002-9378. |
| ABSTRACT | |
| OBJECTIVE | In
this study outpatient and inpatient expectant management for complete placenta
previa were compared in terms of maternal and neonatal outcome and overall cost.
|
| STUDY
DESIGN | We
reviewed the outcomes and hospital costs of 72 mother-infant pairs where the pregnancy
was complicated by second- or third-trimester placenta previa and was managed
expectantly either with hospitalization or outpatient bed rest. The data were
analyzed with the two-sided unpaired t test, chi 2, and simple correlation analysis. |
| RESULTS | There
were no differences in maternal morbidity as measured by estimated total blood
loss, number of blood transfusions, nadir hematocrit, or need for emergency delivery.
Fetal mortality was comparable in both groups, and there were no significant differences
in neonatal morbidity as measured by gestational age, birth weight, 5-minute Apgar
score, or occurrence of fetal distress. Among outpatients the number of maternal
hospital days was reduced by 50% (p <0.01). Outpatient management achieved a hospital
cost reduction of 48.5% for mothers (p < 0.001) and 39.4% for mother-infant pairs
(p < 0.05). |
| CONCLUSION | In
selected patients outpatient management of complete placenta previa can be cost-effective
and safe. Author. |
| 8. AUTHOR | Silver-R,
Depp-R, Sabbagha-R-E, Dooley-S-L, Socol-M-L, Tamura-R-K. |
| INSTITUTION | Department
of Obstetrics and Gynecology, Northwestern University Medical School, Chicago,
Illinois. |
| TITLE | Placenta
previa: aggressive expectant management. |
| SOURCE | Am-J-Obstet-Gynecol
1984 Sep 1, VOL: 150 (1), P: 15-22, ISSN: 0002-9378. |
| ABSTRACT | We
report the outcomes of 95 expectantly managed cases of placenta previa; all were
diagnosed after 21 weeks' gestation. Patients at risk for preterm delivery because
of hemorrhage or preterm labor received aggressive care, including multiple transfusions,
volume expansion and tocolytic therapy, and amniotic fluid surfactant determinations,
to achieve the goal of delivery at 37 weeks' gestation with mature fetal lung
function. We present guidelines for outpatient management and double setup examination
prior to delivery. The role of ultrasound in diagnosis (three asymptomatic cases;
13 cases with preterm labor) and serial placental localization to determine the
timing, route, and place of delivery is presented. Eighty-six percent of 19 infants
born weighing less than 2500 gm were managed expectantly. Hemorrhage was the determinant
in delivery timing in 50 cases. All four deaths were neonatal with birth weights
less than 2200 gm. This is the lowest perinatal mortality rate (4.2%) published
to date. Use of this aggressive approach is particularly suitable for patients
cared for in a teritary center. Author. |
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