title: Using ultrasound in the clinical management of placental implantation abnormalities.
abstract: Placental implantation abnormalities, including placenta previa, placenta accreta, vasa previa, and velamentous cord insertion, can have catastrophic consequences for both mother and fetus, especially as pregnancy progresses to term. In these situations, current recommendations for management usually call for an indicated preterm delivery even in asymptomatic patients. However, the recommended gestational age(s) for delivery in asymptomatic patients are empirically determined without consideration of the recent literature regarding the usefulness of specific ultrasound findings to help individualize management. The purpose of this article is to propose literature-supported guidelines to the current opinion-based management of asymptomatic patients with placental implantation abnormalities based on relevant and specific ultrasound findings such as cervical length, distance between the internal cervical os and placenta, and placental edge thickness.
authors.affiliation: Department of Obstetrics and Gynecology, Winthrop University Hospital, Mineola, NY. Electronic address: avintzileos@winthrop.org.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Vintzileos
authors.affiliation: Department of Obstetrics and Gynecology, College of Physicians and Surgeons, and Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.affiliation: Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA; Department of Obstetrics and Gynecology, University of South Florida-Morsani College of Medicine, Tampa, FL.
authors.forename: John C
authors.initials: JC
authors.lastname: Smulian
mesh_terms: D058070:Asymptomatic Diseases / Q000628:therapy*; D054791:Cervical Length Measurement; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D010920:Placenta / Q000000981:diagnostic imaging*; D010921:Placenta Accreta / Q000000981:diagnostic imaging* / Q000628:therapy; D010923:Placenta Previa / Q000000981:diagnostic imaging* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D055949:Vasa Previa / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: bleeding; hemorrhage; imaging; marginal or low-lying previa; placenta accreta; placenta previa; pregnancy; sonography; vasa previa; velamentous umbilical cord insertion