Mode of birth in women with low-lying placenta: protocol for a prospective multicentre 1:3 matched case–control study in Italy (the MODEL-PLACENTA study)

Abstract

IntroductionThe term placenta praevia defines a placenta that lies over the internal os, whereas the term low-lying placenta identifies a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1–20 mm from the internal cervical os (internal-os-distance). The most appropriate mode of birth in women with low-lying placenta is still controversial, with the majority of them undergoing caesarean section. The current project aims to evaluate the rate of vaginal birth and caesarean section in labour due to bleeding by offering a trial of labour to all women with an internal-os-distance >5 mm as assessed by transvaginal sonography in the late third trimester.Methods and analysisThe MODEL-PLACENTA is a prospective, multicentre, 1:3 matched case–control study involving 17 Maternity Units across Lombardy and Emilia-Romagna regions, Italy. The study includes women with a placenta located in the lower uterine segment at the second trimester scan. Women with a normally located placenta will be enrolled as controls. A sample size of 30 women with an internal-os-distance >5 mm at the late third trimester scan is needed at each participating Unit. Since the incidence of low-lying placenta decreases from 2% in the second trimester to 0.4% at the end of pregnancy, 150 women should be recruited at each centre at the second trimester scan. A vaginal birth rate ≥60% in women with an internal-os-distance >5 mm will be considered appropriate to start routinely admitting to labour these women.Ethics and disseminationEthical approval for the study was given by the Brianza Ethics Committee (No 3157, 2019). Written informed consent will be obtained from study participants. Results will be disseminated by publication in peer-reviewed journals and presentation in international conferences.Trial registration numberNCT04827433(pre-results stage)

Haemodynamic stability following adrenaline intracervical block for major haemorrhage during surgical management of late miscarriage: A case report

“…The placenta is low positioned in early gestation; however, in over 90% of women with the low-lying placenta in the second trimester, the placenta apparently tends to migrate upwards following the development of the lower uterine segment during the third trimester of pregnancy [ 19 ]. This could explain the drop in the incidence of the low-lying placenta from 2% in the second trimester (reported at 1–5%) to 0.4% at the end of pregnancy [ 20 ].…”

Trial of Labor Compared With Elective Cesarean Delivery for Low-Lying Placenta

“…11,22 Intrapartum hemorrhage was defined as blood loss that required emergency cesarean delivery. 5,11,26 The main secondary endpoint was severe maternal morbidity (SMM), as previously described 24,[27][28][29] and defined by any of the following: uterine artery embolization or emergency surgery to control PPH, transfusion of more than 5 units of packed red blood cells, transfer to the intensive care unit, thromboembolic events, and death. Another secondary endpoint was severe neonatal morbidity including: 5-minute Apgar score less than 7, umbilical artery pH less than 7.10, need for resuscitation or intubation with transfer to the neonatal intensive care unit, and neonatal death.…”

The method for termination of mid-trimester pregnancy with placenta previa: A case study

“…Low-positioned placenta can be classified into placenta previa and low-lying placenta. [1][2][3] The placenta previa is defined as the placenta partially or completely covering the internal os. In contrast, the low-lying placenta is defined as the placenta that is partially implanted in the lower uterine segment with the length from the lower edge of the placenta to the internal cervical os <20 mm.…”