Resolution of a Low‐Lying Placenta and Placenta Previa Diagnosed at the Midtrimester Anatomy Scan

Durst, J; Tuuli, Methodius G.; Temming, Lorene A.; Hamilton, Owen; Dicke, Jeffrey M.

doi:10.1002/jum.14554

Cited by 22 publications

(42 citation statements)

References 19 publications

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“…One study found that vaginal ultrasound helped diagnose low-lying placenta or placenta previa in nearly 1 in 10 women. [ 5 ] MRI has good soft tissue contrast and clearly shows the placenta position and the depth of myometrial invasion. MRI and computed tomography can be valuable for a placenta previa diagnosis when ultrasound results are unclear.…”

Section: Discussionmentioning

confidence: 99%

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Chen²

2020

Medicine

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Introduction: The clinical treatment is complicated for patients with placenta previa who must terminate pregnancy due to fetal malformation, death, or inevitable abortion in the second trimester. It is difficult to manage excessive bleeding during pregnancy termination; and those patients face risks of removing the uterus, infection and other complications. Patient concerns: Two patients had placenta previa in the second trimester. Both cases had to terminate pregnancy. Case 1 patient had intrauterine fetal death. Case 2 patient had life-threatening vaginal bleeding. Both patients had bleeding and their cervix was not mature during vaginal delivery. Diagnosis: After hospitalization, placenta previa was confirmed by magnetic resonance imaging for case 1 patient. Placenta previa was confirmed by ultrasound examination for case 2 patient. Both patients had to terminate pregnancy. Interventions: We designed a new procedure using a cervical ripening balloon to reduce the risks during pregnancy termination for patients with placenta previa. A cervical ripening balloon was inserted through the placenta and placed between the fetus and placenta; external force was applied to keep the cervical ripening balloon pressing against the placenta that covers the cervical os. The cervical ripening balloon dilated the cervix, quickly reduced bleeding, and induced vaginal delivery during pregnancy termination for patients with placenta previa. This method was applied to 2 patients with placenta previa who must terminate pregnancy. Outcomes: Using the new method, both patients had a successful pregnancy termination and vaginal delivery with minimal bleeding. Total time from the balloon placement to the end of the delivery was about 3 hours. The procedure only used a cervical ripening balloon without uterine artery embolization needed. The fetus was delivered through the vagina; and the uterus was fully retained. There was no postpartum infection. Conclusion: This new method using a cervical ripening balloon could be a quick and effective way to reduce the risks during pregnancy termination for patients with placenta previa. It is especially helpful in emergency situations with minimal requirements of personnel and equipment. Our study showed great potential of this new utilization of a cervical ripening balloon, and is worthy of further research.

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Section: Discussionmentioning

confidence: 99%

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Chen²

2020

Medicine

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“…Resolution was noted in 99.5% in women with an IOD of 10-20 mm, 95.4% with an IOD of 0.1-10mm and 72.3% with a placenta previa. 7 The higher percentage of normal location of second trimester low-lying placentas compared to placenta previa might be due to trophotropism. This is a process of atrophy of the thin placental margins due to a poor vascular supply in the lower uterine segment, whereas other placenta regions continue to grow and migrate towards sites with a higher vascular density in the fundal region of the uterus.…”

Section: Discussionmentioning

confidence: 99%

“…13 The higher rate of persistence of placentas on the posterior side compared to the anterior side found in our cohort was also described by others. 7,13,14 It might be associated with dynamic placentation, in which the anterior uterine wall expands more than the posterior wall. Since the uterus grows gradually by elongation and hypertrophy during pregnancy, the lower uterine segment will lengthen.…”

Section: Accepted Articlementioning

confidence: 99%

“…Thus, the necessity of follow-up ultrasound examination in the third trimester for all women with a lowpositioned placenta in the second trimester can be questioned. 7 Besides the additional costs of follow-up ultrasound, diagnosis of a low-positioned placenta in the second trimester may also have a psychological impact on patients and caretakers. 8 It could create needless fear for bleeding or other pregnancy complications, potentially contributing to more elective and emergency caesarean sections.…”

Section: Introductionmentioning

confidence: 99%

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Follow‐up ultrasound in second‐trimester low‐positioned anterior and posterior placentae: prospective cohort study

Jansen

Kleinrouweler

Kastelein

et al. 2020

Ultrasound in Obstet & Gyne

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Objectives-The majority of placenta previa and low-lying placentas in the second trimester will have a normal position in the third trimester. We assessed the accuracy for the distance between the placenta and the internal os of the cervix in the second trimester to predict third trimester lowpositioned placentas and defined a cutoff value at which all third trimester low-positioned placentas are identified.

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“…11 However; there is no consensus about the exact distance, which can give the obstetricians a high sensitivity rate of diagnosis. 12 Additionally, the maternal characteristics may be also having a role in prediction of PP.…”

Section: Introductionmentioning

confidence: 99%

Evolution of second trimester low implanted placenta to previa at term: a prospective cohort study

Shaaban

Ahmed²,

Ali

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: The objective of this study is to identify the percentage of low implanted placenta (LIP) at second trimester of pregnancy and identify the risk factors of its persistence to placenta previa (PP) at term.Methods: Through a registered prospective cohort study conducted at tertiary hospital in Upper Egypt, authors screened all pregnant ladies comes to present facility for antenatal second trimester USG between 18-24 weeks gestation. All participants interviewed for detailed risk factors of placenta previa. Those diagnosed to have a LIP (≤1.5 cm from the internal os) had had TVS to confirm the exact distance between the lower edge of the placenta and the internal os. Serial USG had been done every 4 weeks up to delivery to measure the same distance. The primary outcome was the percentage of LIP at 18-24 weeks. Logistic regression analysis was performed to predict the risk factors for PP at term.Results: Through screening of 1000 pregnant lady, LIP had been identified in (52 cases) 5.2% of pregnant women between 18-24 weeks. This percentage dropped gradually to reach 1.3% at 36 weeks of gestation and at time of delivery. The logistic regression analysis demonstrated that the distance between the internal os and the lower edge of the placenta between 18-24 weeks was the single significant variable associated with PP at term (p<0.001, odds ratio 0.319, 95% CI 0.20-0.50). However, excluding the distance from the regression model demonstrated other risk factors as previous miscarriage, previous cesarean section (CS), and history of multiple pregnancies and history of previous PP.Conclusions: About 5.0% of pregnant women have LIP at the second trimester of pregnancy (18-24 weeks) and only 25.0 % of them remain placenta previa at term. A cut-off value of 10 mm between the internal os and the lower edge of the placenta is the most important predictor of development of PP.

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Resolution of a Low‐Lying Placenta and Placenta Previa Diagnosed at the Midtrimester Anatomy Scan

Abstract: A low-lying placenta or placenta previa diagnosed at the midtrimester anatomy survey resolves in most patients. Resolution is near universal in patients with an initial distance from the internal os of 10 mm or greater.

Cited by 22 publications

References 19 publications

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Using a cervical ripening balloon to penetrate the placenta and quickly reduce bleeding by pressing against the placenta during pregnancy termination for patients with placenta previa in the second trimester

Follow‐up ultrasound in second‐trimester low‐positioned anterior and posterior placentae: prospective cohort study

Evolution of second trimester low implanted placenta to previa at term: a prospective cohort study

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