title: Blood loss in low-lying placenta: placental edge to cervical internal os distance of less vs. more than 2 cm.
abstract: OBJECTIVE
  To reconfirm that a low-lying placenta, with placental edge-internal os distance of 0-4 cm, is a risk factor for blood loss during delivery, and to determine whether blood loss differs between edge-os distance of < or =2 cm vs. >2 cm.
  
  
  METHODS
  We compared total blood loss between 73 singleton pregnant women with edge-os distance of 0-4.0 cm vs. controls. We also compared total blood loss between pregnant women with distance of 0-2.0 cm (lower) vs. 2.1-4.0 cm (higher).
  
  
  RESULTS
  Total blood loss was significantly greater in women with placental edge-os distance of < or =4 cm than controls in both delivery modes. The lower group showed a significantly higher incidence of excessive hemorrhage during vaginal delivery (60 vs. 19%, P=0.046) and bled more (median 1240 vs. 860 mL, P=0.059) than the higher group. Although this did not reach statistical significance, the lower group more frequently bled antepartum, required emergent cesarean section, and delivered abdominally. Regression analysis showed no association between the amount of blood loss and the edge-os distance in both delivery modes.
  
  
  CONCLUSIONS
  Pregnant women with edge-os distance of 2.1-4.0 cm are of highest level of concern as are women with 0-2.0 cm distance.
authors.affiliation: Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan. matsushi@jichi.ac.jp
authors.forename: Shigeki
authors.initials: S
authors.lastname: Matsubara
authors.forename: Akihide
authors.initials: A
authors.lastname: Ohkuchi
authors.forename: Masashi
authors.initials: M
authors.lastname: Kikkawa
authors.forename: Akio
authors.initials: A
authors.lastname: Izumi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kuwata
authors.forename: Rie
authors.initials: R
authors.lastname: Usui
authors.forename: Takashi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D010920:Placenta / Q000000981:diagnostic imaging* / Q000473:pathology; D006473:Postpartum Hemorrhage / Q000473:pathology*; D011247:Pregnancy; D012016:Reference Values; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal / Q000592:standards