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Third‐trimester transvaginal ultrasonography in placenta previa: does the shape of the lower placental edge predict clinical outcome?
Open accessAbstract
Objective: To evaluate the clinical significance of the shape of the lower placental edge in women with transvaginal sonographic diagnosis of placenta previa. Design: A prospective observational study at a tertiary teaching hospital. Population: A total of 104 women with confirmed transvaginal sonographic diagnosis of placenta previa before 32 weeks' gestation. Methods: Initial transvaginal sonography was performed at between 28 and 32 weeks' gestation in 138 patients with either strong clinical suspicion or previous abdominal sonographic diagnosis of placenta previa in the early third trimester. The lower placental edge was found to be positioned over the internal cervical os in 33 women (complete previa) and within 3 cm from it in 71 women (low‐lying placenta). Patients with low‐lying placenta were followed up by serial transvaginal sonographic examinations until delivery; detailed information including the placental location (anterior or posterior), the distance of its edge from the internal cervical os and its thickness were recorded. The clinical outcomes of the 17 who had a thick‐edge low‐lying placenta were compared with those who had a thin‐edge one (54 women). In patients with complete placenta previa, demographic data, the shape of the lower placental edge whenever transvaginal sonography visualized it, and the clinical outcomes were documented. The incidence of major complications in thick‐edge or central placenta was compared to that in the thin‐edge group. Results: Women having a low‐lying placenta with a thick edge had a significantly higher rate of antepartum hemorrhage (P = 0.0002), abdominal delivery (P = 0.02), abnormally adherent placenta (P = 0.012) and low birth weight (P = 0.006) than those in whom the placental edge was thin. Cesarean hysterectomy was required in six patients with complete placenta previa because of severe peripartum hemorrhage; all of them had either central or thick‐edge placenta accreta. Conclusion: Women with placenta previa are at a relatively higher risk of developing complications if the lower placental edge is thick. Integration of the shape of the lower placental edge into transvaginal sonographic assessment of placenta previa may improve the prediction of mode of delivery and clinical outcome. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
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“These additional ultrasound features are poorly defined, not routinely assessed in UK practice”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [76]
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“Women presenting with a placental edge less than 20 mm from the internal os in the third trimester are more likely to need delivery by caesarean section when the placental edge is thicker (over 10 mm) 75,76 and/or contains a sponge-like echo 77 or marginal 'sinus'.78”
From Placenta Praevia and Placenta Accreta: Diagnosis and Management: Green‐top Guideline No. 27a (2019) · cites this paper as [76]
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(2015) · Donald School Journal of Ultrasound in Obstetrics & Gynecology · doi:10.5005/jp-journals-10009-1511 · Cited by 1
Boog, G., & Merviel, P. (2003) · EMC - Ginecología-Obstetricia · doi:10.1016/s1283-081x(03)71910-9 · Cited by 1
Krapp, M., & Axt-Fliedner, R. (2005) · Der Gynäkologe · doi:10.1007/s00129-005-1694-0 · Cited by 1
The Role of Ultrasound in Intrapartum Care
Sanaullah, F., Moran, P., & Loughney, A. D. (2002) · Ultrasound · doi:10.1177/1742271x0201000406 · Cited by 1
Gibson, J., Sabir, N., & Neilson, J. P. (2018) · doi:10.1002/9781119072980.ch39 · Cited by 1
Nojiri, T., Yoshizato, T., Sanui, A., Araki, R., Obama, H., Shirota, K., & Miyamoto, S. (2015) · Taiwanese Journal of Obstetrics and Gynecology · doi:10.1016/j.tjog.2013.11.011
Sadek, S. M., & Ahmad, R. A. (2014) · Middle East Fertility Society Journal · doi:10.1016/j.mefs.2014.12.001
Best Practice & Research Clinical Obstetrics and Gynaecology
Bhidé, A. (2014)
Ultrasonography in infertility
Rizk, B. (2010) · Cambridge University Press eBooks · doi:10.1017/cbo9780511776854.010
Raughley, M. J., & LaMonica, G. E. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.040
Cesarean Delivery Complications and Cesarean Hysterectomy
Altizer, M. D. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.009
Dermatologic Disorders and Pregnancy
Stockdale, C. K., & Martini, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.046
Akinlaja, O. A., & Gist, W. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.032
Management of Obstetric Umbilical Cord Complications
Bressman, P. L. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.006
Elson, M. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316662571.047
Metadata
- Authors
- Ghourab, S.
- Affiliations
- King Saud University (SA)
- Corresponding author
- Ghourab, S.
- ORCID
- Ghourab, S.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2001-08
- Volume
- 18
- Issue
- 2
- Pages
- 103-108
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W1974068772
- Cited by
- 159
- References
- 19
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 6 · 2020: 4 · 2019: 7 · 2018: 11 · 2017: 61 · 2016: 2 · 2015: 4 · 2014: 4 · 2013: 4 · 2012: 3
- FWCI
- 2.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
- Health Sciences › Medicine › Hematology › Blood transfusion and management
- Keywords
- placenta previa, transvaginal ultrasound, low-lying placenta, complete placenta previa, antepartum hemorrhage, mode of delivery, placenta accreta, cesarean hysterectomy, low birth weight, placental location
- MeSH terms
- Adult, Female, Humans, Placenta Previa, Predictive Value of Tests, Pregnancy, Pregnancy Trimester, Third, Prospective Studies, Ultrasonography, Prenatal, Endosonography
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