Diagnosis of low-lying placenta: can migration in the third trimester predict outcome?
OBJECTIVE
To investigate the relationship between the rate of migration of a low-lying placenta during the third trimester and the eventual route of delivery.


METHODS
All patients with a placenta lying within 3 cm of the internal cervical os or overlapping it on transvaginal ultrasound at > or = 26 weeks' gestation were included in the study. The exact distance between the center of the internal cervical os and the leading edge of the placenta was measured by transvaginal sonography, repeated at approximately 4-week intervals until delivery.


RESULTS
The mean rates of migration in patients who had (n = 7) and who did not have (n = 29) Cesarean section for placenta previa were +0.3 mm/week and +5.4 mm/week, respectively (P < 0.0001). When the placental edge was initially > 20 mm from the internal os, migration occurred in all cases and no Cesarean section for placenta previa was performed. For those between -20 mm and +20 mm, sufficient migration to avoid Cesarean section occurred in 88.5% of cases. Beyond a 20 mm overlap, significant placental migration did not occur and all patients required Cesarean section.


CONCLUSIONS
Placental migration may occur progressively throughout the third trimester. The initial position of the placental edge and the subsequent rate of migration can be used to predict the eventual route of delivery.
Oppenheimer
L
L
Division of Maternal-Fetal Medicine, Ottawa Hospital, General Campus 501 Smyth, University of Ottawa, Ontario, Canada K1H 8L6. loppenheimer@ottawahospital.on.ca
Holmes
P
P
Simpson
N
N
Dabrowski
A
A
D000328:Adult; D005260:Female; D006801:Humans; D010923:Placenta Previa / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal