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. 2000;2003(2):CD001998.
doi: 10.1002/14651858.CD001998.

Interventions for suspected placenta praevia

J P Neilson  1
Affiliations

Interventions for suspected placenta praevia

J P Neilson. Cochrane Database Syst Rev. 2000.

Update in

Abstract

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.

Reviewer's 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.

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Conflict of interest statement

None known.

References

References to studies included in this review

Cali 1998 {published data only}
    1. Cobo E, Conde‐Agudelo, Delgado J, Canaval H, Congote A. Cervical cerclage: an alternative for the management of placenta previa?. American Journal of Obstetrics and Gynecology 1998;179:122‐5. - PubMed
Los Angeles 1996 {published data only}
    1. Wing DA, Paul RH, Millar LK. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management. American Journal of Obstetrics and Gynecology 1996;175:806‐11. - PubMed
St Louis 1988 {published data only}
    1. Arias F. Cervical cerclage for the temporary treatment of patients with placenta previa. Obstetrics & Gynecology 1988;71:545‐8. - PubMed

References to studies excluded from this review

Foshan 1998 {published data only}
    1. Lu h, Guo X, Zheng Y. Expectant treatment of placenta previa with ritodrine. Chung‐Hua Fu Chan Ko Tsa Chih [Chinese Journal of Obstetrics and Gynecology] 1998;33:204‐5. - PubMed
Los Angeles 1991 {published data only}
    1. Sherman SJ, Carlson DE, Platt LD, Medearis AL. Transvaginal ultrasound: does it help in the diagnosis of placenta previa?. American Journal of Obstetrics and Gynecology 1991;164:344. - PubMed
Tulsa 1984 {published data only}
    1. D'Angelo LJ, Irwin LF. Conservative management of placenta previa: a cost‐benefit analysis. American Journal of Obstetrics and Gynecology 1984;149:320‐3. - PubMed

References to studies awaiting assessment

Hong 2003 {published data only}
    1. Hong JY, Jee YS, Yoon HJ, Kim SM. Comparison of general and epidural anesthesia in elective cesarean section for placenta previa totalis: maternal hemodynamics, blood loss and neonatal outcome. International Journal of Obstetric Anesthesia 2003;12:12‐6. - PubMed
Jaswal 2006 {published data only}
    1. Jaswal A, Manaktala U, Sharma JB. Cervical cerclage in expectant management of placenta previa. International Journal of Gynecology & Obstetrics 2006;93(1):51‐2. - PubMed
Scotland/Jordan 1999 {published data only}
    1. Sunna E, Ziadeh S. Transvaginal and transabdominal ultrasound for the diagnosis of placenta praevia. Journal of Obstetrics and Gynaecology 1999;19(2):152‐4. - PubMed
Sharma 2004 {published data only}
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Sherman 1992 {published data only}
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Verspyck 2008 {published data only}
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References to other published versions of this review

CDSR 2002
    1. Neilson JP. Interventions for suspected placenta praevia (Cochrane Review). The Cochrane Library 2002, Issue 4.
Neilson 1995
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