Placenta Previa Follow-up

  • Author: Saju Joy, MD, MS; Chief Editor: Carl V Smith, MD   more...
 
Updated: Feb 25, 2010
 

Further Inpatient Care

If hemorrhage occurs, monitor hemoglobin and hematocrit levels for anemia and transfuse if necessary (eg, hemoglobin level < 8). Order clotting studies (ie, PT/aPTT, fibrinogen, and fibrin split product) if concern arises for DIC.

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Complications

  • Hemorrhage (Hemorrhage is expected secondary to the poor contractibility of the lower uterine segment. Planning delivery and control of hemorrhage is critical in cases of placenta previa as well as placenta accreta, increta, and percreta.)
  • Preterm delivery
  • Congenital malformations
  • Abnormal fetal presentation
  • Placental abruption
  • Higher rates of blood transfusion[1]
  • Increased incidence of postpartum endometritis[1]
  • Hemostasis may be established by one or more of the following:
    • Oversewing the placental implantation site
    • Bilateral uterine artery ligation
    • Internal iliac artery ligation
    • Circular interrupted ligation around the lower uterine segment both above and below the transverse incision
    • Packing with gauze or tamponading with the Bakri balloon catheter
    • B-lynch stitch
    • Cesarean hysterectomy
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Prognosis

  • Fifty percent of women with placenta previa have preterm delivery.
  • Those cases complicated with vaginal bleeding and extreme prematurity are at an increased risk of perinatal death.
  • A greater incidence of fetal malformations and growth restriction is noted with placenta previa.
  • An increased risk of neurodevelopmental delay and sudden infant death syndrome (SIDS) is associated with placenta previa.[4]
  • Neonates are also more likely to have low birth weight (< 2500 g), respiratory distress syndrome, jaundice, NICU admissions, and longer hospital stay.[1]
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Patient Education

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Contributor Information and Disclosures
Author

Saju Joy, MD, MS  Associate Director, Division Chief of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Carolinas Medical Center

Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Lyon, MD  Director, Division of Gynecology, Associate Professor, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville

Deborah Lyon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of American Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Florida Medical Association

Disclosure: Nothing to disclose.

Ryan A Stone, MD  Fellow, Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Section, Wake Forest University Health Sciences

Ryan A Stone, MD is a member of the following medical societies: Academic Pediatric Association, American College of Obstetricians and Gynecologists, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard S Legro, MD  Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center

Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons

Disclosure: Korea National Institute of Health and National Institute of Health (Bethesda, MD) Honoraria Speaking and teaching; Greater Toronto Area Reproductive Medicine Society (Toronto, ON, CA) Honoraria Speaking and teaching; American College of Obstetrics and Gynecologists (Washington, DC) Honoraria Speaking and teaching; National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Think Tank Panel (Bethesda, MD) Honoraria Speaking and teaching; University of Illinois (Chicago, IL) Honoraria Speaking and teaching; Georgetown University Hospital (Washington, DC) Honoraria Speaking and teaching; Heilongjiang University (Harbin, China) Speaking and teaching; New England Fertility Society (Nashua, NJ) Honoraria Speaking and teaching; William Beaumont Hospital Division of Reproductive Endocrinology and Infertility (Detroit, MI) Honoraria Speaking and teaching; Wayne State University School of Medicine (Detroit MI) Honoraria Speaking and teaching

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD  The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

References

  1. Zlatnik MG, Cheng YW, Norton ME, Thiet MP, Caughey AB. Placenta previa and the risk of preterm delivery. J Matern Fetal Neonatal Med. Oct 2007;20(10):719-23. [Medline].

  2. Ghi T, Contro E, Martina T, Piva M, Morandi R, Orsini LF, et al. Cervical length and risk of antepartum bleeding in women with complete placenta previa. Ultrasound Obstet Gynecol. Feb 2009;33(2):209-12.

  3. Choi SJ, Song SE, Jung KL, Oh SY, Kim JH, Roh CR. Antepartum risk factors associated with peripartum cesarean hysterectomy in women with placenta previa. Am J Perinatol. Jan 2008;25(1):37-41.

  4. Creasy RK, Resnik R, Iams J , Lockwood C, Moore T. Placenta previa and abruptio placentae. In: Creasy and Resnik's Maternal-Fetal Medicine: Principles and Practice: Expert Consult. 6th ed. Philadelphia, Pa: WB Saunders; 2008:725-29.

  5. Masamoto H, Uehara H, Gibo M, Okubo E, Sakumoto K, Aoki Y. Elective use of aortic balloon occlusion in cesarean hysterectomy for placenta previa percreta. Gynecol Obstet Invest. 2009;67(2):92-5.

  6. Bhide A, Prefumo F, Moore J, et al. Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia. BJOG. Sep 2003;110(9):860-4. [Medline].

  7. Butler EL, Dashe JS, Ramus RM. Association between maternal serum alpha-fetoprotein and adverse outcomes in pregnancies with placenta previa. Obstet Gynecol. Jan 2001;97(1):35-8. [Medline].

  8. Comstock CH, Love JJ, Bronsteen RA, et al. Sonographic detection of placenta accreta in the second and third trimesters of pregnancy. Am J Obstet Gynecol. Apr 2004;190(4):1135-40. [Medline].

  9. Creasy RK, Resnik R, Clark SL. Placenta previa and abruptio placentae. In: Creasy RK, Resnik R, eds. Maternal-Fetal Medicine. 4th ed. Philadelphia, Pa: WB Saunders; 1999:616-21.

  10. Cunningham FG, MacDonald PC. Obstetrical hemorrhage. In: Cunningham FG, Gilstrap LC, Gant NF, Leveno KJ, Hauth JC, Wenstrom KD, eds. Williams Obstetrics. 20th ed. New York, NY: McGraw-Hill; 1997:755-60.

  11. Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med. Mar 2003;13(3):175-90. [Medline].

  12. Gabbe SJ, Benedetti TJ. Obstetric hemorrhage. In: Gabbe SJ, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 3rd ed. New York, NY: Churchill Livingstone; 1996:510-5.

  13. Gilliam M, Rosenberg D, Davis F. The likelihood of placenta previa with greater number of cesarean deliveries and higher parity. Obstet Gynecol. Jun 2002;99(6):976-80. [Medline].

  14. Harma M, Gungen N, Ozturk A. B-Lynch uterine compression suture for postpartum haemorrhage due to placenta praevia accreta. Aust N Z J Obstet Gynaecol. Feb 2005;45(1):93-5. [Medline].

  15. Hwu YM, Chen CP, Chen HS, Su TH. Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section. BJOG. Oct 2005;112(10):1420-3. [Medline].

  16. Laughon SK, Wolfe HM, Visco AG. Prior cesarean and the risk for placenta previa on second-trimester ultrasonography. Obstet Gynecol. May 2005;105(5 Pt 1):962-5. [Medline].

  17. Miller DA, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa-placenta accreta. Am J Obstet Gynecol. Jul 1997;177(1):210-4. [Medline].

  18. Mustafa SA, Brizot ML, Carvalho MH, et al. Transvaginal ultrasonography in predicting placenta previa at delivery: a longitudinal study. Ultrasound Obstet Gynecol. Oct 2002;20(4):356-9. [Medline].

  19. Oppenheimer L, Society of Obstetricians and Gynaecologists of Canada. Diagnosis and management of placenta previa. J Obstet Gynaecol Can. Mar 2007;29(3):261-73. [Medline].

  20. Ornan D, White R, Pollak J, Tal M. Pelvic embolization for intractable postpartum hemorrhage: long-term follow-up and implications for fertility. Obstet Gynecol. Nov 2003;102(5 Pt 1):904-10. [Medline].

  21. Oyelese Y, Smulian JC. Placenta previa, placenta accreta, and vasa previa. Obstet Gynecol. Apr 2006;107(4):927-41. [Medline].

  22. Predanic M, Perni SC, Baergen RN, Jean-Pierre C, Chasen ST, Chervenak FA. A sonographic assessment of different patterns of placenta previa "migration" in the third trimester of pregnancy. J Ultrasound Med. Jun 2005;24(6):773-80. [Medline].

  23. Usta IM, Hobeika EM, Musa AA, Gabriel GE, Nassar AH. Placenta previa-accreta: risk factors and complications. Am J Obstet Gynecol. Sep 2005;193(3 Pt 2):1045-9. [Medline].

  24. Ward CR. Avoiding an incision through the anterior previa at cesarean delivery. Obstet Gynecol. Sep 2003;102(3):552-4. [Medline].

  25. Warshak CR, Eskander R, Hull AD, Scioscia AL, Mattrey RF, Benirschke K. Accuracy of ultrasonography and magnetic resonance imaging in the diagnosis of placenta accreta. Obstet Gynecol. Sep 2006;108(3 Pt 1):573-81. [Medline].

  26. Weinstein A, Chandra P, Schiavello H, Fleischer A. Conservative management of placenta previa percreta in a Jehovah's Witness. Obstet Gynecol. May 2005;105(5 Pt 2):1247-50. [Medline].

  27. Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. May 2005;192(5):1458-61. [Medline].

 
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Placenta previa.
Placenta previa covering the entire cervical os.
Placenta previa partially separated from the lower uterine segment.
Placenta previa invading the lower uterine segment and covering the cervical os.
Table. Morbidities and Their Relative Risk
MorbiditiesRelative Risk
Antepartum bleeding10
Need for hysterectomy33
Blood transfusion10
Septicemia5.5
Thrombophlebitis5
Endometritis6.6[1]
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