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The Role of Transvaginal Sonography in the Diagnosis of Placenta Praevia
Author(s) -
Tan Niap H.,
Abu Marlik,
Woo Jean L.S.,
Tahir Hashim M.
Publication year - 1995
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.1995.tb01828.x
Subject(s) - medicine , placenta , obstetrics , ultrasonography , vaginal bleeding , pregnancy , vaginal delivery , gynecology , surgery , fetus , genetics , biology
EDITORIAL COMMENT: We accepted this paper for publication because it confirms that vaginal probe ultrasonography is safe if performed carefully in women who have had antepartum bleeding and who are likely to have a placenta praevia Our understanding of the data presented here is that vaginal probe ultrasonography is more accurate than transabdominal ultrasonography in diagnosis of lesser degrees of placenta praevia. This is important now that it has become accepted practice to manage women with placenta praevia at home especially if there has been no major episode of bleeding. Vaginal probe ultrasonography is also useful to avoid misdiagnosis of placenta praevia and unnecessary hospitalization of such patients: this seems very likely to occur if praevia is diagnosed when transabdominal ultrasound shows the placental edge to be within 5 cm of the internal os. Readers are referred to the article by Rosen DMB and Peek MJ “Do women with placenta praevia without antepartum haemorrhage require hospitalization?‘ Aust NZ J Obstet Gynaecol 1994; 34: 2: 130) and the Editorial Comment which accompanied this paper. There are 2 remaining important questions about the antenatal management of a patient with placenta praevia where conservative management is an option. The first is when is it safe to allow the woman home when she has had an episode of haemorrhage, and the second is when should hospitalization be recommended in the absence of haemorrhage when there is a major degree of placenta praevia? One of the main points in this paper is that many days hospitalization could be saved by using transvaginal ultrasound for the diagnosis of placenta praevia. However, this argument seems based on the assumption that women were hospitalized unnecessarily because of misdiagnosis of placenta praevia, which is quite a different argument.Summary: Transvaginal sonography was performed in 70 patients diagnosed to have placenta praevia by transabdominal sonography. The diagnosis was confirmed either by digital examination in theatre at term or operative finding at delivery. Forty‐nine cases (70%) were correctly diagnosed to have placenta praevia by both modes of sonography. Transvaginal sonography ruled out placenta praevia in 12 cases (17%) thought to be placenta praevia by transabdominal ultrasound. Both transabdominal and transvaginal sonography demonstrated ‘placental migration’ in 4 cases (6%) which were no longer praevia at delivery. Five patients (7%) were erroneously believed to have placenta praevia by both sonographic techniques. Overall, the diagnostic accuracy of transvaginal sonography was 92.8% compared with 75.7% for transabdominal sonography. None of the subjects experienced any exacerbation of bleeding or other complications. The results suggest that transvaginal sonographic localization of the placenta is safe and superior to the transabdominal route.