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Early identification of placenta praeviaDear Sir, We are very pleased to have seen this paper by McClure and Dornan [Br J Obstet Gynaecol (1990) 97,959-9611. The findings were similar to the ones we found from our investigations. We are, however, rather disappointed that McClure and Dornan did not separate the anterior from the posterior low-lying placentas. We would like to emphasize the need for this particular classification as we found in our patients with placenta praevia that at term those with a posterior lowlying placenta did not show 'placental migration' as was seen in those with an anterior low-lying placenta. This confirmed an earlier observation by Macafee et al. (1%2) that in most women with placenta praevia the low-lying placenta was posterior. We therefore reiterate the point made at the end of our paper (Ruparelia & Chapman 1985), that re-scanning after the early detection of a low-lying placenta should be restricted to those with a posterior low-lying placenta, and also those who bleed during their antenatal period. B. A. Ruparelia Consultant Obstetrician 959-%l.

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Placenta previa in association with placenta accreta has been recorded on average in 1 in 500 pregnancies; its association with placenta percreta is a much rarer condition. We report an unusual case of placenta previa which presented as a severe form of occult parasitic infiltration, invading the internal iliac vessels. This was followed by life-threatening complications, despite preventative measures. Use of a prediction index to suspect placenta previa is mentioned.