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A substantive amendment to this systematic review was last made on 17 August
1999. Cochrane reviews are regularly checked and updated if necessary.
Background: Because placenta praevia is implanted unusually low in the
uterus, it may cause major, and/or repeated, antepartum haemorrhage. The
traditional policy of care of women with symptomatic placenta praevia
includes prolonged stay in hospital and delivery by caesarean section.
Objectives: To assess the impact of any clinical intervention applied
specifically because of a perceived likelihood that a pregnant woman might
have placenta praevia.
Search strategy: A comprehensive electronic search was performed to identify
relevant literature. Searched databases included the Trials Register
maintained by the Cochrane Pregnancy and Childbirth Group, and the Cochrane
Controlled Clinical Trials Register.
Selection criteria: Any controlled clinical trial that has assessed the
impact of an intervention in women diagnosed as having, or being likely to
have, placenta praevia.
Data collection and analysis: Data were extracted from the three identified
trial reports, unblinded, by the author without consideration of results.
Main results: Two comparisons could be made - home versus hospitalisation and
cervical cerclage versus no cerclage. Both were associated with reduced
lengths of stay in hospital antenatally. Otherwise, there was little evidence
of any clear advantage or disadvantage to a policy of home versus hospital
care. Cervical cerclage may reduce the risk of delivery before 34 weeks, or
the birth of a baby weighing less than 2 kg or having a low 5 minute Apgar
score. In general, these possible benefits were more evident in the trial of
lesser methodological quality.
Reviewers' conclusions: There are insufficient data from trials to recommend
any change in clinical practice. Available data should, however, should
encourage further work to address the safety of more conservative policies of
hospitalisation for women with suspected placenta praevia, and the possible
value of insertion of a cervical suture.
Citation: Neilson JP. Interventions for suspected placenta praevia (Cochrane
Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.
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For those of you who are interested in reading other Cochrane abstracts on
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chilbirth topics, go to:
http://www.update-software.com/ccweb/cochrane/revabstr/g010index.htm
Robert Modugno MD MBA FACOG
Marietta, GA
