Different routes and forms of uterotonics for treatment of retained placenta: a randomized clinical trial*

Objectives: To compare between three different uterotonics (oxytocin, carbetocin and misoprostol) given via three different routes (intraumbilical, intravenous and sublingual, respectively) in reducing the need for manual removal of placenta (MROP).

Methods: A randomized trial for cases with retained placenta 30?min following vaginal delivery. They received intraumbilical oxytocin, intravenous carbetocin or sublingual misoprostol. Main outcome measures were delivery of the placenta within 30?min following drug administration, and need for MROP. Secondary outcome measures were injection to placental delivery time, post-delivery hemoglobin, need for blood transfusion or additional uterotonics.

Results: The overall success rate was 66.7% (64/96), 71.3% (67/94) and 63.7% (58/91) for oxytocin, carbetocin and misoprostol groups, respectively (p?>?0.05). When time needed to achieve placental delivery considered, a significant difference was observed with the shortest time for carbetocin (16.61?±?3.76?min), then oxytocin (18.28?±?3.34?min) and lastly misoprostol (23.00?±?3.38?min) (p?<0.001). Again, carbetocin group needed less additional uterotonics to achieve adequate uterine contractions (p?<0.001).

Conclusions: Although we aimed to exploit the advantage of certain drug over another, all seemed to have close efficacy but it would be important that further research should highlight availability, cost, ease of administration and storage requirements to determine which agent would best be used in this clinical scenario.     

Sublingual nitroglycerin for management of retained placenta.

OBJECTIVE: The aim of the study was to investigate the effect of sublingual nitroglycerin for management of retained placenta and to assess possible adverse effects of the treatment. METHOD: Twenty-four women were randomly selected to receive either 1 mg nitroglycerin or placebo tablets sublingually if intravenous oxytocin and controlled umbilical cord traction had failed to expel the placenta. Success rate for delivery of placenta, blood pressure, pulse rate, blood loss, and various side effects were examined. RESULT: All 12 women in the nitroglycerin group had successful delivery of placenta, while removal of placenta was successful in only one of the 12 women in the placebo group. No adverse effects of clinical importance were registered. CONCLUSION: Sublingual nitroglycerin for treatment of retained placenta seems to be effective without causing serious adverse effects. However, the definite clinical value needs to be evaluated in larger series of patients.     

Reoccurrence of retained placenta at a subsequent delivery: an observational study

Objective: To test the generalizability of previously reported increased risk of reoccurrence of retained placenta in yet another setting.

Methods: In this observational retrospective study we longitudinally followed women who had a vaginal delivery complicated by a partial or complete retained placenta at Edith Wolfson Medical Center between 1 January 2009 and 31 December 2012. The study group included parturient women who had a partial or complete retained placenta after a vaginal delivery (n?=?90). The control group included parturient women who did not have a partial or complete retained placenta after a vaginal delivery from the same time period using the same inclusion criteria (n?=?90).

Results: Retained partial or complete placenta at a previous delivery was found to be an independent risk factor for retained partial or complete placenta in a subsequent delivery (adjusted OR 9.8, 95%CI 1.2 to 80.6, p?=?0.032) and for retained partial or complete placenta and/or postpartum hemorrhage in a subsequent delivery (adjusted OR 14.1, 95% CI 1.7 to 111.9, p?=?0.012), after controlling for gestational age and induction of labor at previous delivery.

Conclusion: Retained partial or complete placenta at an index delivery increases the risk of reoccurrence of retained partial or complete placenta in a subsequent delivery.     

Planned vaginal delivery versus planned cesarean delivery in cases of low-lying placenta

Objective: To assess the applicability of trial of labor in cases of low-lying placenta.

Methods: In this observational cohort study, we collected data from the women with low-lying placenta delivered at our hospital between April 2012 and December 2015. Low-lying placenta was diagnosed when the length from the placental lowest edge to the internal cervical os (placenta-os distance) was 0–20?mm at 36 gestational weeks. Planned mode of delivery for each case was determined by patient’s preference. Maternal and neonatal outcomes were compared between the planned vaginal delivery group (N?=?11) and the planned cesarean delivery group (N?=?7).

Results: All the women in the planned cesarean delivery group underwent scheduled cesarean section at 37–38 gestational weeks. Three cases in the planned vaginal delivery group required emergency cesarean section for uncontrollable antepartum bleeding. The intrapartum blood loss was significantly smaller in the planned vaginal delivery group than in the planned cesarean delivery group (946?±?204?g vs. 1649?±?256?g, p?=?0.047). Umbilical arterial blood pH was similar between the two groups. All the women requiring emergency cesarean section were accompanied by marginal sinus.

Conclusions: Trial of labor can be offered to all the women with low-lying placenta except for those accompanied by marginal sinus.     

The incidence and risk factors for retained placenta after vaginal delivery – a single center experience

Abstract

Objective: We aimed to determine the incidence and risk factors for retained placenta immediately after vaginal delivery in a single, university-affiliated tertiary center.

Methods: A case-control study. Women who delivered vaginally and diagnosed with suspected retained placenta were compared to control group of women with spontaneous vaginal delivery with spontaneous non-complicated placental separation between the years 2007 and 2012. Eligibility was limited to singleton fetuses in vertex presentation with no history of more than one cesarean section, stillbirth or major fetal anomaly.

Results: Overall, 33?925 women delivered vaginally, of them, 491 (1.4%) underwent revision of uterine cavity due to suspected retained placenta. Women with retained placenta were characterized by a higher rate of previous cesarean section (OR 1.71, 95% CI 1.23–2.36), previous abortions, lower parity (OR 0.79, 95% CI 0.68–0.91), lower gestational age at delivery. Hypertensive disorders, oligohydramnios and labor and delivery interventions as induction of labor (OR 1.84, 95% CI 1.30–2.59), neuro-axial analgesia (OR 1.60, 95% CI 1.27–2.00) and vacuum delivery (OR 1.89, 95% CI 1.48–2.41) were independently associated with uterine revision for retained placenta.

Conclusion: Risk factors for manual revision due to retained placenta can be recognized. This data should be taken into consideration in the assessment of women immediately after delivery.     

Benefits of cord blood collection in the prevention of post-partum hemorrhage: a cohort study

Objective: The aim of this study was to assess the benefit of umbilical cord drainage through cord blood collection (CBC) for the prevention of post-partum hemorrhage (PPH).

Methods: This is a retrospective cohort study based on data collected prospectively including all vaginal delivery of singletons pregnancies after 37 weeks of gestation between July 2011 and May 2013 at the Strasbourg Teaching Hospital. We performed a univariate comparison of PPH risk factors with χ² tests and then we built multivariate logistic regressions to predict PPH, severe PPH (>1000?cc), retained placenta over 30?min and manual removal of the placenta.

Results: A total of 7810 vaginal deliveries were analyzed, among which 1957 benefited from CBC (25%). In the CBC group, 71 PPH (3.6%) were observed versus 260 (4.4%) in the control group (p?=?0.12). In multivariate analysis, after adjustment on PPH risk factors, CBC revealed to be a protective factor of PPH: OR?=?0.69 (95% CI 0.50–0.97; p?=?0.03). CBC is neither a significant predictive factor of severe PPH, time to placental delivery nor rate of manual removal of the placenta.

Conclusions: In our study, CBC and thus umbilical cord drainage was a protective factor against PPH but it did reduce neither retained placenta nor the need for artificial placental delivery.     

Comparison of induction of labor methods for unfavorable cervices in trial of labor after cesarean delivery

Objective: To compare induction of labor methods in patients attempting a trial of labor after cesarean (TOLAC) with an unfavorable cervix.

Methods: This is a retrospective cohort study from patients attempting TOLAC from 2009 to 2013. Patients with a simplified Bishop score of three or less where labor was initiated with either a Cook balloon or oxytocin were included. Our primary outcome was mode of delivery. Our secondary outcomes included duration of labor and multiple maternal and neonatal morbidities.

Results: Two-hundred and fourteen women met inclusion criteria: 150 received oxytocin and 64 had the Cook balloon placed. The vaginal birth after cesarean delivery rate was significantly higher in the oxytocin group at 70.7% versus 50.0% in the Cook balloon group (p?=?0.004). In the multivariable analysis, odds for cesarean delivery were two times higher with the Cook balloon than with oxytocin (Adjusted OR?=?2.09, 95% CI?=?1.05-4.18, p?=?0.036). The duration of labor was longer with the Cook balloon versus oxytocin (21.9 versus 16.3?hours, p?=?0.0002). There were no significant differences in maternal and neonatal health outcomes.

Conclusion: Oxytocin induction of labor was associated with a higher rate of vaginal delivery and a shorter duration of labor compared to the Cook balloon in women undergoing TOLAC with an unfavorable cervix.     

Effects of acupressure at the Sanyinjiao point (SP6) on the process of active phase of labor in nulliparas women

Introduction.?The reduction of the duration and pain of the active phase of labor is a very important issue and therefore always under serious investigation.

Objective.?The purpose of the present study is to evaluate the effect of acupressure at the Sanyinjiao point (SP6) on the duration and pain of the active phase of labor in nulliparas women.

Method.?A single blind randomized clinical trial was performed on 120 eligible nulliparas women who were at the beginning of active phase of labor (3–4?cm dilatation of cervix plus proper uterine contractions). The women were randomly assigned into two groups. The case group (n?=?60), received acupressure at Sanyinjiao point (above the ankle), for 30?min during contractions. In the control group (n?=?60), simply a touch at this point without massage was performed. Two hours later a second pelvic examination was performed and in the absence of good forceful contractions oxytocin in the classical form was infused. Finally, duration of active phase, severity of pain (using the Visual Analogue Scale), the amount of necessary oxytocin and necessity to administer oxytocin and the route of delivery were compared between the two groups and statistical analyses were performed using SPSS 15.

Results.?The mean duration of active phase was shorter in the case group (252.37?±?108.50?min vs. 441.38?±?155.88, p?=?0.0001). Six patients (10%) in the case group and 25 patients (41.7%) in the control group delivered via cesarean section (p?=?0.0001). The severity of pain in the case group was less than the control group (5.87?±?1.77 vs. 6.79?±?1.52, p?=?0.003). Twenty-five women (41.7%) in the case group and 38 women (63.3%) in the control group needed oxytocin (p?=?0.017) The amount of necessary oxytocin in the case group was less than the control group (73.33?±?97.19?ml vs. 126.6?±?97.19?ml, p?=?0.003).

Conclusion.?Acupressure at Sanyinjiao point (SP6) reduced the duration and severity of pain of the active phase of labor, cesarean section rates, and necessity and amount of oxytocin.     

Use of intracervical balloons and chorioamnionitis in term premature rupture of membranes

Objective: To determine whether ripening and induction in patients with term premature rupture of membranes (PROM) via intracervical balloon placement (ICB) increases the risk of chorioamnionitis when compared to women with term PROM ripened and induced with other methods.

Study design: A retrospective cohort study of term singleton gestations undergoing ripening and induction after PROM between July 2009 and June 2012 was conducted. Exposure of interest was ICB placement. Primary outcome of interest was chorioamnionitis. Statistical analysis included bivariate and multivariate techniques.

Results: Of 124 term PROM patients, 42 were ripened by ICB with or without oxytocin (33.9%) and 82 were ripened and induced with oxytocin (66.1%). More women ripened with an ICB were nulliparous (n?=?35, 83.3% ICB versus n?=?44, 53.7% oxytocin, p?=?0.001). Chorioamnionitis was slightly more common in women ripened with ICB and/or oxytocin versus oxytocin alone but difference did not reach statistical significance (p?=?0.10). The rate of cesarean delivery, intrauterine pressure catheter (IUPC) use, and median lengths of membrane rupture and active labor were higher in the ICB group. After adjustment, chorioamnionitis was not correlated with ICB placement but with nulliparity [AOR 12.5 (1.36, 114.6), p?=?0.03] and IUPC use [AOR 4.39 (1.04, 18.5), p?=?0.04].

Conclusion: Nulliparity and IUPC, not ICB placement, were associated with chorioamnionitis.     

Placenta previa associated with severe bleeding leading to hospitalization and delivery: a retrospective population-based cohort study

Introduction: The aim of our study was to compare maternal and neonatal outcomes in women with placenta previa complicated with severe bleeding leading to hospitalization until delivery versus those without severe bleeding episodes.

Methods: This is a population-based retrospective cohort study including all pregnant women with placenta previa who delivered at our medical center in the study period, divided into the following groups: 1) women with severe bleeding leading to hospitalization resulting with delivery (n?=?32); 2) patients with placenta previa without severe bleeding episodes (n?=?1217).

Results: Out of all women with placenta previa who delivered at our medical center, 2.6% (32/1249) had an episode of severe bleeding leading to hospitalization and resulting with delivery. The rate of anemia was lower (43.8% versus 63.7%, p?=?0.02) while the need for blood transfusion higher (37.5% versus 21.1%, p?=?0.03) in the study group. The rate of cesarean sections was significantly different between the groups, and a logistic regression model was constructed in order to find independent risk factors for cesarean section in our patients.

Conclusion: To the best of our knowledge, this is the first study to evaluate the impact of severe bleeding on the outcome of pregnancies complicated with placenta previa. Our study demonstrates that, in women with placenta previa, severe bleeding does not lead to increased adverse maternal or neonatal outcomes.     

Effect of intraumbilical vein oxytocin injection on third stage of labor

ObjectiveManual removal of placenta is performed in 1–3% of cases, and although it is a well-established and relatively safe procedure, it is not without complications. We carried out this study to determine whether intraumbilical vein oxytocin injection reduces the need for manual removal of placenta and shortens the third stage of labor, in comparison with placebo.Materials and MethodsIn this randomized clinical trial, 178 women with singleton pregnancy and normal delivery were studied in 1 year. Immediately after fetus delivery, oxytocin infusion (20 IU/L) was started in both groups. Moreover, 10 IU oxytocin and 1 mL normal saline were injected into the umbilical vein of women in the experimental and control groups, respectively. The duration of third-stage labor, need for manual delivery of placenta, and drug side effects were evaluated in both groups. With regard to the mean level of hemoglobin before and after delivery, the two groups were compared using the Levene test and independent t test, and other qualitative variables of the two groups were compared using the χ² test.ResultsThe women who received intraumbilical vein oxytocin had a shorter third stage of labor as compared with the placebo group (4.24 ± 3.27 min vs. 10.66 ± 7.41) (p < 0.001) and there was less need for manual delivery of placenta in the experiment group (1.1% vs. 5.1%) (p = 0.024).ConclusionIt was concluded that intraumbilical vein administration of 10 IU (1 mL) oxytocin immediately after fetus delivery was clinically effective in shortening the third stage of labor.     

The use of 17-hydroxy progesterone in women with arrested preterm labor: a randomized clinical trial

Abstract

Background: The use of 17-alpha-hydroxyprogesterone caproate (17?P) has been shown to reduce preterm delivery in women who have had a prior preterm birth. The role of 17?P in women with arrested preterm labor is less certain.

Aims: To compare the preterm birth rate and neonatal outcome in women with arrested preterm labor randomized to receive 17?P or placebo.

Materials and methods: Women with arrested preterm labor were randomized to weekly injections of either 17?P (250?mg) or placebo. Maternal and neonatal outcome were evaluated.

Results: Forty-five singleton pregnancies were randomized after successful tocolysis; 22 received 17?P while 23 got placebo. Gestational age at delivery (p?=?0.067) and the interval from treatment to delivery (p?=?0.233) were not affected by 17?P. Significantly less women in the 17?P group delivered at <34 weeks (14 versus 21, p?=?0.035). There was also a significant reduction in the risk of neonatal sepsis (p?=?0.047) and gr III/IV intraventricular hemorrhage (IVH) (p?=?0.022) in the 17?P group.

Conclusion: In this study, 17?P did not delay the interval to delivery after successful preterm labor, but births <34 weeks as well as neonatal sepsis and IVH were reduced by 17?P treatment.     

Sublingual misoprostol is as effective as intravenous oxytocin to reduce intra-operative blood loss during cesarean delivery in women living at high altitude

Objective: To assess the effect of sublingual misoprostol compared to intravenous oxytocin for blood loss during cesarean delivery in women living at high altitude.

Study design: In a randomized trial, conducted in Quito, Ecuador (2800?m above sea level), 100 women received either sublingual misoprostol (400?µg) or intravenous oxytocin (10?IU).

Results: Bleeding in the misoprostol was no different than in the oxytocin group. Shivering was reported in 66% of women in the misoprostol group.

Conclusion: Sublingual misoprostol might be a valid alternative to oxytocin reduce intra-operative blood loss during cesarean section in women living at high altitude.     

Intravenous carbetocin shot is superior to oxytocin infusion for placental delivery in second trimester abortion: a pilot randomized controlled trial

Objective: To study the efficacy of 100?μg intravenous shot of carbetocin compared to 20?IU oxytocin intravenous infusion to prevent placental retention in second trimester medical termination of pregnancy.

Methods: A double-blinded randomized controlled trial was conducted at Ain Shams University Maternity Hospital from 1 April 2013 to 30 November 2013. A total of 132 women between 14 and 24 weeks gestation indicated for termination were randomized to receive either 20?IU oxytocin infusion (n?=?66) or 100?μg carbetocin shot (n?=?66) after fetal expulsion. Patients were observed for time elapsed between fetal and placental expulsion, presence of placental retention and blood loss.

Results: Third stage was 33.4?±?20.4?min in oxytocin group & 23.1?±?16.8?min in carbetocin group (p?=?0.002). Eight patients (12.1%) in oxytocin group had complete placental retention versus two patients (3.0%) in carbetocin group (p?=?0.05). Eight patients (13.8%) received oxytocin had remnants of placenta compared to four patients (6.2%) received carbetocin (p?=?0.04). Sixteen patients (24.2%) received oxytocin and six patients (9%) received carbetocin needed surgical curettage (p?=?0.04). Third stage blood loss was 87.2?±?33.7?ml in carbetocin and 206.9?±?35.2?ml in oxytocin groups (p?=?0.001).

Conclusion: Carbetocin is superior to oxytocin infusion for management of placental delivery in second trimester abortion.     

Evaluating the effects of copper supplement during pregnancy on premature rupture of membranes and pregnancy outcome

Objective: To evaluate the effects of copper (Cu) supplementation during pregnancy on the rupture of membranes and pregnancy outcomes.

Methods: Study was conducted as a triple-blind randomized clinical trial. In one group, Cu in a dose of 1000?mg per day, and in the other group, placebo was prescribed orally from 16th week of pregnancy.

Results: The women of the two groups did not have significant difference according to age, gestational age at recruitment, BMI, and socioeconomic conditions. There was no statistically significant difference between case and control group regarding the incidence of PPROM, PROM, preterm labor, vaginal bleeding during pregnancy, preeclampsia, and the incidence of placenta abruption. There was a 75% and 90% decrease in depressive symptoms in 2nd trimester and 3rd trimester in supplemented group, respectively. Also, there was a 45% and 80% decrease in anxiety symptoms in 2nd trimester and 3rd trimester in the supplemented group, respectively The rate of infection during pregnancy was significantly higher in control group (p?=?0.046). There was no difference between the two groups according to neonatal outcomes.

Conclusions: Cu supplementation during pregnancy could not influence positively on ROM; however, it could improve some mood status of the women.     

Foley catheter with simultaneous oxytocin on labor induction: a meta-analysis of randomized controlled trials

Objective: It is unclear that whether Foley catheter with simultaneous oxytocin could improve the efficacy of induction outcome.

Method: To conduct a meta-analysis of randomized controlled trial (RCT) studies to evaluate the effect of Foley catheter with simultaneous oxytocin on labor induction. PubMed, Embase, and other databases were searched from their inception to July 2017. We included all RCTs comparing Foley catheter with simultaneous oxytocin (i.e. intervention group) with Foley catheter followed by oxytocin (i.e. control group) in the three kinds of women (nulliparas and multiparas/only nulliparas/only multiparas). We estimate summarized relative risk (RR) and 95% confidence intervals (CIs) for dichotomous outcomes, standard mean difference for continuous outcomes. Fixed- and random-effects models were used, depending on heterogeneity.

Results: After application of our inclusion and exclusion criteria, six RCTs with a total of 1133 participants were identified. We found that only nulliparas had significant RR of delivery within 24?h (RR?=?1.32, 95% CI: 1.12, 1.55, I²?=?46.5%). Meanwhile, there was no statistically significant difference between intervention and control groups in vaginal delivery in 24?h, cesarean delivery, time to delivery, and Apgar score at 5?min less than 7. Foley catheter with simultaneous oxytocin did not increase the risk of side effects, included chorioamnionitis, postpartum hemorrhage, uterine hyperstimulation, and neonatal intensive care unit admission.

Conclusion: The results seem to support the use of oxytocin to a Foley catheter at the initiation of labor induction, as it might lead to increases the rate of delivery within 24?h in nulliparas.     

Induction of labor in women with a uterine scar

Objective: To evaluate the frequency of uterine rupture following induction of labor in women with a previous cesarean section. Misoprostol was compared to other methods of induction.

Methods: A retrospective cohort study of 208 women attempting induction of labor after one previous cesarean section. Delivery data were collected retrospectively and compared. Group 1(2009–2010) was compared with Group 2 (2012–2013). In Group 1, the main method of induction was vaginal PGE₂ (prostaglandin-E₂), amniotomy, oxytocin or a balloon catheter. In Group 2, the dominant method of induction was an oral solution of misoprostol. Main outcome measures: frequency of uterine rupture in the two groups.

Results: Nine cases (4.3%) of uterine rupture occurred. There was no significant difference in the frequency of uterine rupture following the change of method of induction from PGE₂, amniotomy, oxytocin or mechanical dilatation with a balloon catheter to orally administered misoprostol (4.1 versus 4.6%, p?=?0.9). All ruptures occurred in women with no prior vaginal delivery.

Conclusion: The shift to oral misoprostol as the primary method of induction in women with a previous cesarean section did not increase the frequency of uterine rupture in the cohort studied.     

Ultrasound imaging in prolonged second stage of labor: does it reduce the operative delivery rate?

Abstract

Objective: To reduce the operative delivery rate in the prolonged second stage of labor (PSSL) through intrapartum sonography.

Methods: Sixty-two women – with uncomplicated pregnancies at term, fetus in cephalic presentation and occipitoanterior position, in PSSL – had already undergone epidural anesthesia and oxytocin infusion. Transperineal ultrasound was performed to define fetal head direction (downward, horizontal, and upward) and patients were divided into three groups (D, H, and U).

Proposed protocol: Cessation of oxytocin infusion, addition of a dose of anesthesia, invitation to assume a hand-and-knee position, and to relax. After one hour, oxytocin infusion was started again and women were invited to push. Fetal well-being ensured by cardiotocography (CTG). Chi-square test was used to compare the mode of delivery: cesarean section (CS), vacuum extraction (VE), and spontaneous delivery (SD).

Results: Group D (n?=?20): 4 SD (20%), 4 VE, 12 CS; group H (n?=?22): 9 SD (41%), 9 VE, 4 CS; group U (n20): 16 SD (80%), 4 VE. The risk of not having a SD in group D versus U is quadrupled (RR 4; 95% CI 1.6–9.9).

Conclusions: Ultrasound diagnosis of fetal head upward direction is highly predictive of SD in case of PSSL. Further studies are needed to assess this hypothesis.     

Can contraction patterns predict neonatal outcomes?

Abstract

Objective: To estimate the association between contraction patterns in labor and neonatal outcomes.

Methods: A nested case–control study within a consecutive term birth cohort included women in labor with intrauterine pressure catheters (IUPCs) who reached the second stage. Cases were women delivering neonates with composite morbidity: special care or intensive care unit admission, umbilical artery pH?≤?7.1 or 5-min Apgar < 7. The control group delivered without any components of the composite morbidity. Contraction frequency, duration, relaxation time, Montevideo units (MVUs) and baseline tone in the last 30?min prior to delivery were compared. We used logistic regression to adjust for potential confounders and receiver operating characteristic curves to evaluate the ability of contraction parameters to predict adverse neonatal outcomes.

Results: There were 183 cases of adverse neonatal outcomes and 2172 controls without the composite outcome. Contraction duration, relaxation time, MVUs and baseline tone did not significantly differ between the groups. Tachysystole was more common in women with the adverse neonatal outcome (21% versus 15%, p?=?0.01). A model including tachysystole, oxytocin use and nulliparity did not adequately predict the adverse outcome (AUC?=?0.61).

Conclusions: Although tachysystole is associated with adverse neonatal outcomes, uterine activity cannot be used to predict neonatal outcome.     

Conservative management of placenta previa complicated by abnormal placentation

Abstract

Objective: Abnormal implantation of placenta previa is life-threatening condition. The purpose of this study was to evaluate the impact of the conservative management of pregnancies with such complication on maternal morbidity rate and the chance for uterine preservation (fertility).

Methods: Eleven patients with abnormal implantation of placenta previa were analyzed prospectively. This complication was diagnosed antenatally by two-dimensional ultrasound and color flow Doppler. The following outcomes were analyzed: need for blood transfusion, admission and duration of stay in intensive care unit, infections, coagulopathies, time between cesarean section and delivery of placenta, hysterectomy and preservation of uterus.

Results: Among the 20 085 women who had a singleton gestation, 11 (0.054%) were identified with placenta previa with abnormal placentation. In five patients (group A), hysterectomy was performed because of hemorrhage or placenta ablation. In six patients (group B), conservative management succeeded and placenta were preserved. In group A, placenta were delivered earlier (2?d–8 weeks) in comparison with group B (6–15 weeks). Estimated blood loss during the delayed delivery of placenta was higher in the group with hysterectomy (respectively, 450–1600 and 300–500?ml).

Conclusions: Conservative management of placenta previa with abnormal implantation decreases the risk of severe hemorrhage at the time of delivery and can preserve fertility.