Clinical and ultrasound assessment in patients with placenta previa to predict the severity of intrapartum hemorrhage

Objectives: Evaluate whether maternal history and ultrasound can predict massive hemorrhage during cesarean section in placenta praevia.Study design: Sixty singleton pregnant women with persistent placenta praevia (after 28 weeks' gestation) were prospectively enrolled in this study.Comprehensive maternal history and findings obtained by antenatal ultrasound, including placental location, presence of lacunae, lack of a clear zone, abnormal color Doppler indices were reviewed, and their effect on the severity of maternal hemorrhage during cesarean section was analyzed.Results: Twenty two cases had massive intra operative hemorrhage, among them 20 patients were confirmed to have placenta accreta and its variants (including increta and percreta) at the time of cesarean delivery.For diagnosis of severe bleeding (> 1500 ml), the sensitivity of previous uterine surgery, abnormal color Doppler and lack of clear zone was high (95.5%, 81.8%, 81.8% respectively) while sensitivity of presence of lacunae was low (36.4%). And the specificity of abnormal color Doppler, lack of clear zone and presence of lacunae was high (94.7%, 94.7%, 97.4% respectively) while of previous uterine surgery was low (36.8%).Conclusion: Prenatal maternal history and ultrasound examination can predict the amount of intraoperative hemorrhage and reduced the morbidity and mortality in patients with placenta previa. (C) 2013 Production and hosting by Elsevier B. V.