Complete Placenta Previa: Ultrasound Biometry and Surgical Outcomes
04 August 2017
23 February 2018
20 April 2018 (online)
Objective To evaluate the relationship between surgical outcomes and ultrasound measurement of placental extension beyond the cervical os in women with placenta previa.
Study Design This is a retrospective cohort study of singleton pregnancies with placenta previa undergoing third-trimester ultrasound and delivering at our institution from 2002 through 2011. For study purposes, an investigator measured placental extension, defined as the placental distance from the internal os across the placenta continuing out to the lowest placental edge. If morbidly adherent placentation was suspected, women were excluded. Receiver operating characteristic (ROC) curves were developed for pertinent surgical outcomes, and multivariate analysis was performed to determine the placental extension with the best predictive discriminatory zone.
Results In total, 157 women had placenta previa, ultrasound, and delivery data: 86 (55%) had a placental extension of <40 mm, and 71 (45%) had a placental extension of ≥40 mm. Women with placental extension of ≥40 mm had increased surgical time, blood loss > 2,000 mL, blood transfusion, and rate of peripartum hysterectomy. After multivariate analysis, only peripartum hysterectomy and surgical time > 90 minutes remained significant, p ≤ 0.05 and p ≤ 0.01, respectively.
Conclusion In women with placenta previa, the placental extension ultrasound measurement of ≥40 mm is a predictor of adverse surgical outcomes.
This study was presented at the Society for Maternal-Fetal Medicine 35th Annual Meeting, Poster Session IV, February 2–6, 2015.
- 1 Berg CJ, Callaghan WM, Syverson C, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol 2010; 116 (06) 1302-1309
- 2 Faiz AS, Ananth CV. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies. J Matern Fetal Neonatal Med 2003; 13 (03) 175-190
- 3 Frederiksen MC, Glassenberg R, Stika CS. Placenta previa: a 22-year analysis. Am J Obstet Gynecol 1999; 180 (6 Pt 1): 1432-1437
- 4 Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2003. Natl Vital Stat Rep 2005; 54 (02) 1-116
- 5 Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol 1993; 168 (05) 1424-1429
- 6 Rosenberg T, Pariente G, Sergienko R, Wiznitzer A, Sheiner E. Critical analysis of risk factors and outcome of placenta previa. Arch Gynecol Obstet 2011; 284 (01) 47-51
- 7 Cunningham FG. Obstetrical hemorrhage. In: William's Obstetrics. 24rd edition. New York, NY: McGraw-Hill Medical; 2014: 799-804
- 8 Onwere C, Gurol-Urganci I, Cromwell DA, Mahmood TA, Templeton A, van der Meulen JH. Maternal morbidity associated with placenta praevia among women who had elective caesarean section. Eur J Obstet Gynecol Reprod Biol 2011; 159 (01) 62-66
- 9 Crane JMG, Van den Hof MC, Dodds L, Armson BA, Liston R. Maternal complications with placenta previa. Am J Perinatol 2000; 17 (02) 101-105
- 10 Shellhaas CS, Gilbert S, Landon MB. , et al; Eunice Kennedy Shriver National Institutes of Health and Human Development Maternal-Fetal Medicine Units Network. The frequency and complication rates of hysterectomy accompanying cesarean delivery. Obstet Gynecol 2009; 114 (2 Pt 1): 224-229
- 11 Wright JD, Devine P, Shah M. , et al. Morbidity and mortality of peripartum hysterectomy. Obstet Gynecol 2010; 115 (06) 1187-1193
- 12 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 2008; 25 (01) 37-41
- 13 Daskalakis G, Simou M, Zacharakis D. , et al. Impact of placenta previa on obstetric outcome. Int J Gynaecol Obstet 2011; 114 (03) 238-241
- 14 Giambattista E, Ossola MW, Duiella SF. , et al. Predicting factors for emergency peripartum hysterectomy in women with placenta previa. Arch Gynecol Obstet 2012; 285 (04) 901-906
- 15 Grobman WA, Gersnoviez R, Landon MB. , et al; National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network. Pregnancy outcomes for women with placenta previa in relation to the number of prior cesarean deliveries. Obstet Gynecol 2007; 110 (06) 1249-1255
- 16 Yaegashi N, Chiba-Sekii A, Okamura K. Emergency postpartum hysterectomy in women with placenta previa and prior cesarean section. Int J Gynaecol Obstet 2000; 68 (01) 49-52
- 17 Reddy UM, Abuhamad AZ, Levine D, Saade GR. ; Fetal Imaging Workshop Invited Participants. Fetal imaging: Executive summary of a Joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. Am J Obstet Gynecol 2014; 210 (05) 387-397
- 18 Tuzovic L. Complete versus incomplete placenta previa and obstetric outcome. Int J Gynaecol Obstet 2006; 93 (02) 110-117
- 19 Baba Y, Matsubara S, Ohkuchi A. , et al. Anterior placentation as a risk factor for massive hemorrhage during cesarean section in patients with placenta previa. J Obstet Gynaecol Res 2014; 40 (05) 1243-1248
- 20 Hasegawa J, Matsuoka R, Ichizuka K. , et al. Predisposing factors for massive hemorrhage during Cesarean section in patients with placenta previa. Ultrasound Obstet Gynecol 2009; 34 (01) 80-84
- 21 Young BC, Nadel A, Kaimal A. Does previa location matter? Surgical morbidity associated with location of a placenta previa. J Perinatol 2014; 34 (04) 264-267
- 22 American College of Obstetricians and Gynecologists. ACOG committee opinion no. 560: Medically indicated late-preterm and early-term deliveries. Obstet Gynecol 2013; 121 (04) 908-910
- 23 Saitoh M, Ishihara K, Sekiya T, Araki T. Anticipation of uterine bleeding in placenta previa based on vaginal sonographic evaluation. Gynecol Obstet Invest 2002; 54 (01) 37-42
- 24 Rac MWF, Dashe JS, Wells CE, Moschos E, McIntire DD, Twickler DM. Ultrasound predictors of placental invasion: the Placenta Accreta Index. Am J Obstet Gynecol 2015; 212 (03) 343.e1-343.e7
- 25 Silver RM, Landon MB, Rouse DJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol 2006; 107 (06) 1226-1232