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Re: April fools' marginal placenta previa. From: art fougner, md (evsono@pipeline.com) Mon Apr 2 13:54:59 2007 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Previous message: R. Daniel Braun: "Re: April fools' marginal placenta previa." In reply to: R. Daniel Braun: "Re: April fools' marginal placenta previa." Next in thread: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Reply: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Reply: R. Daniel Braun: "Re: April fools' marginal placenta previa." Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia * Amarnath Bhide, * Federico Prefumo**Dr F. Prefumo, Fetal Medicine Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK., * Jessica Moore, * Brian Hollis, * Basky Thilaganathan * aFetal Medicine Unit, Academic Department of Obstetrics and Gynaecology, St George's Hospital Medical School, London, UK *Dr F. Prefumo, Fetal Medicine Unit, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. Abstract Objectives To correlate transvaginal ultrasound findings with mode of delivery in cases of placenta praevia. Design Cohort study. Setting A London Teaching Hospital. Methods Retrospective review of all cases of placenta praevia diagnosed by transvaginal ultrasound between February 1997 and March 2002. Main outcome measures Likelihood of vaginal delivery and major obstetric haemorrhage. Results A total of 121 pregnancies were studied with a mean scan-to-delivery interval of 10.5 days. In the 64 women who laboured, the likelihood of vaginal delivery rose significantly as the placental edge to internal os distance increased. Caesarean section rate was 90% when the placental edge–internal os distance was 0.1 to 2.0 cm, falling to 37% when this measurement was over 2.0 cm (P< 0.00045). Conclusion Trial of vaginal delivery is appropriate in cases with a placental to internal os distance>2 cm. The term 'praevia' should be restricted to cases where the placental edge is ≤2 cm from the internal os, as the likelihood of operative delivery and significant postpartum haemorrhage is high. Cases where the placenta is more than 2 cm from the internal os have a greater than 60% chance of vaginal delivery and should be defined as 'low lying' in order to reduce the clinician's bias towards operative delivery. Art At Mon, 2 Apr 2007, R. Daniel Braun wrote: > >I bet someone of "Stature" said "Gee, I think if it isn't at least 3 cm >away, it could bleed a lot." And hence it has been so ever since. >Dan > >On 4/2/07, ainsron <ainsron@sbcglobal.net> wrote: >> >> What is their rationale for a 2cm cutoff?? >> >> Ronald E. Ainsworth, MD, FACOG >> >> -----Original Message----- >> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E. >> Siegel, M.D. >> Sent: Monday, April 02, 2007 9:52 AM >> To: Multiple recipients of list OB-GYN-L >> Subject: Re: April fools' marginal placenta previa. >> >> FWIW, our MFMs quote 2 cm. as the cutoff for allowing a vaginal >> delivery. >> >> Recently saw a scan on a CNM patient, 37 weeks, 9 to 12 mm from the os, >> posterior placenta, previous vaginal delivery then LTC/S for breech. >> >> I got this scan on Friday at 3 PM, called her, and advised a section >> this week or if labors, and explained why. And I quote, "The midwife >> said it was OK." I told her that I was the obstetrician, and, well, my >> opinion was the senior one in this instance and that she was mistaken. >> >> She did not like my advice, and who knows what will happen when she >> comes in this week to see the CNM. >> >> Garry >> >> At Mon, 2 Apr 2007, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. >> wrote: >> > >> >At Sun, 1 Apr 2007, R. Daniel Braun wrote: >> >> >> >>Double Setup WHY??????????????????? >> >>Just cut. >> >>Dan >> >> >> >The patient was expecting a nice midwife no intervention birth and >> >really did not want to have c-section; after the double setup I could >> >honestly tell her sorry that will not happen today. >> > >> >-- >> > Take care, John >> > >> >> -- >> Garry E. Siegel, M.D. >> Private Practice >> Roswell, GA >> >-- >R. Daniel Braun, MD FACOG(L) CMT >Professor Emeritus >Dept. of Obstetrics and Gynecology >Indiana U. School of Medicine > >R. Daniel Braun > > "The way to health is an aromatic bath and scented massage everyday". > Hippocrates > -- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton Next message: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Previous message: R. Daniel Braun: "Re: April fools' marginal placenta previa." In reply to: R. Daniel Braun: "Re: April fools' marginal placenta previa." Next in thread: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Reply: Garry E. Siegel, M.D.: "Re: April fools' marginal placenta previa." Reply: R. Daniel Braun: "Re: April fools' marginal placenta previa."

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