title: Sonographic assessment of placental location: a mere notional description or an important key to improve both pregnancy and perinatal obstetrical care? A large cohort study.
abstract: During a standard obstetrical sonogram, the assessment of placental location (PL) is often limited to a mere notional description without formulating any association to possible implications on pregnancy and childbirth. The aim of the study was to speculate if different sites of PL may have a role in influencing fetal presentation-(FP) at birth and if certain pregnancy-complications may be more closely associated with one rather than with another PL. We conducted an observational-prospective-cohort study on pregnant women referred to the Ob/Gyn Unit of Padua University for routine third-trimester ultrasound scan. For all eligible patients we evaluated the correlation between sites of PL and perinatal maternal/fetal outcomes. Non-cephalic presentation was found in 1.4% of anterior, 8.9% of posterior, 6.2% of fundal and 7.2% of lateral insertions. FP at the beginning of the third trimester as opposed to presentation at birth was concordant in 90.3% of anterior, 63.3% of posterior and 76.5% of lateral insertions. Considering only non-cephalic fetuses we observed a decreasing probability for spontaneous rotation in the following lies: 88% anterior-PL, 80% posterior-PL, 77% lateral-PL, and 70% fundal-PL. Patients with posterior-PL (significantly associated with previous-CS) had a significantly higher CS-rate (due to previous-CS and breech-presentation). Significant differences were found in terms of gestational-hypertension and fresh-placental-weight between different sites of PL. In conclusion our data showed that an understanding of the role that PL plays in influencing the incidence of certain maternal-fetal conditions may assist Clinicians in improving perinatal maternal/fetal outcomes.
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Amerigo
authors.initials: A
authors.lastname: Vitagliano
authors.affiliation: Department of Obstetrics and Gynaecology, University of Verona Verona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Quaranta
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Valentina Di
authors.initials: VD
authors.lastname: Giovanni
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Shara
authors.initials: S
authors.lastname: Borgato
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.affiliation: Department of Woman and Child Health-University of Padua Padua, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: D'Antona
keywords: Placental location; breech presentation; obstetrical ultrasound; perinatal care; pregnancy complication