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The Diagnosis of Marginal Placental Abruption in Placenta Praevia Using Transvaginal Sonography
Author(s) -
Haines Christopher J.,
Stock Anthony
Publication year - 1992
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1992.tb01936.x
Subject(s) - medicine , obstetrics , fetus , gestation , cardiotocography , placenta , antepartum haemorrhage , pregnancy , placental abruption , genetics , biology
EDITORIAL COMMENT The timing of delivery inpatients with recurrent antepartum haemorrhage before practical fetal maturity (37 weeks' gestation) has always required clinical judgement and still does, unless the patient is in labour, or haemorrhage is so severe that conservative management is clearly contraindicated ‐ or the fetus dead, or doomed by irremediable malformations. At earlier gestations maternal and fetal welfare must be assessed (full blood examination and coagulation screen for the mother, and cardiotocography ± biochemical testing of fetoplacental function for the fetus). Estimation of fetal pulmonary maturity may be assessed and maturity enhanced by betamethasone therapy if appropriate. These comments apply not only to patients shown by ultrasonography to have placenta praevia, but also to those where there is evidence of retroplacental bleeding and hence placental separation. This report presents the possible value of transvaginal sonography in patients with recurrent antepartum haemorrhage. The mother was delivered at 35 weeks' gestation and the baby was growth retarded (the Victorian tenth percentile for birth‐weight at 35 weeks is 1,760 g), although this was apparently not recognized before delivery. The timing of delivery was apparently not based upon cardiotocographic or biochemical evidence of fetal compromise. We consider that recurrent antepartum haemorrhage indicates Caesarean delivery, irrespective of the site of the placenta, because of the risk of placental separation in labour. However, the timing of delivery in such patients remains a topic for clinical argument in obstetric practice.