Placenta Praevia—A Study of 174 Cases

Macafee, C. H. G.

doi:10.1111/j.1471-0528.1945.tb07633.x

Cited by 82 publications

(14 citation statements)

References 3 publications

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Section: Introductionmentioning

confidence: 99%

“…While placenta praevia has an approximate incidence of only 0.5% of all pregnancies 1,2 the associated risks of significant haemorrhage to both mother and fetus 3–5 make it an important obstetric complication. Indeed, such are these risks that many clinicians recommend long term hospital admission of women with a placenta praevia so that delivery can be effected quickly should an emergency arise 4,6 . However, while long term inpatient care remains increasingly popular, particularly in North America 7 , this style of management was introduced in the 1940s 2,8 when previously accepted practice had been to expedite delivery in the presence of significant bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Pregnancies complicated by placenta praevia: what is appropriate management?

Love¹,

Wallace

1996

BJOG

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Objective To review the outcome of pregnancies complicated by placenta praevia over a three‐year period (1991–1993) and to describe in detail the antenatal course and the events leading to delivery, assessing retrospectively whether there are clinical features predictive of outcome and whether outpatient management would be reasonable. Design A retrospective review of the case records of women with a pregnancy complicated by placenta praevia. Setting A tertiary referral teaching hospital in Edinburgh. Results There were 15,930 deliveries in the study period. Fifty‐eight women (0.4%) had a placenta praevia in the third trimester, 42 of whom (72%) had at least one episode of bleeding. Overall, 62% of the women had a major praevia with no differences in the grade of praevia between those women who did or did not have bleeding. Both diagnosis and delivery occurred significantly earlier in women with antepartum bleeding than in those without (median gestation at diagnosis 28.6 weeks versus 33.3 weeks (P < 0.01) and at delivery 36.0 weeks versus 37.1 weeks (P= 0.04), respectively). Delivery by emergency caesarean section was more common in women with bleeding (62%versus 38%). An increasing number of bleeding episodes experienced by individuals was not associated with significant differences in outcomes. Rapid emergency delivery for bleeding was necessary for three women, in none of whom could the bleeding have been predicted. Conclusions The clinical outcomes of placenta praevia are highly variable and cannot be predicted confidently from antenatal events. Nonetheless, in the majority of cases with or without bleeding and irrespective of the degree of praevia, outpatient management would appear safe and appropriate.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pregnancies complicated by placenta praevia: what is appropriate management?

Love¹,

Wallace

1996

BJOG

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“…Therefore, if adequate blood replacement therapy is carried out, the expectant treatment will yield larger and more mature infants. By way of supporting this, Macafee (38) points out that in the last 47 cases treated in a large measure expectantly the average weight of the infants was 6 pounds 12 ounces, while in the first 47 cases of his series which were largely treated at the initial hemorrhage, the average infant weight was 5 pounds 2 ounces. Moreover, the fetal mortality was 47 per cent in the early series against 6 per cent in the last 47 cases.…”

Section: Labormentioning

confidence: 93%

“…Where for merly it was advised that pregnancy be terminated as soon as the diagnosis was made, a waiting policy is now recommended in certain favorable cases, with very premature infants. This concept stems from two independently published papers (31,32,38,39) and is based on the point that the first hemor rhage in placenta previa is never fatal in the absence of vaginal manipUlation and subsequent hemorrhages are not fatal in the absence of vaginal manipula tions provided that the hemoglobin was normal at the onset of the hemor rhage. Therefore, if adequate blood replacement therapy is carried out, the expectant treatment will yield larger and more mature infants.…”

Section: Labormentioning

confidence: 99%

Obstetrics

Hellman¹

1950

Annu. Rev. Med.

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The pre. sent review deals with a few of the significant advances in obstetrical practice and theory occurring in the year ending September 1, 1949. PREGNANCYPregnancy tests.-Based on the knowledge that the anterior pituitary hormone and chorionic gonadatropin in pregnant women's urine (1, 2) both have a spermatozoa liberating effect in the male toad, a number of pregnancy tests have been advocated using both male toads (3) and male frogs (4). Employing the male Batrachia,l Galli·Mainini (5) reports the ac· curacy of the results of this pregnancy test in 1,422 verifiable cases. In 916 instances the patient was not pregnant and negative results were obtained in all cases. In 462 cases of verified pregnancy, 458 positive results were obtained. In 623 specimens from nonpregnant subjects, men, women, and children, negative results were obtained in all instances. The rate of accuracy was thus 99.72 per cent. Forty·eight per cent of all the reactiont were positive in 1 hr. ,an additional 40 per cent within 2 hr. and the final 11 per cent within 24 hr.Using Rana pipiens, which is the common North American male frog, it has been reported by Wiltberger & Miller (4) that tests on 200 animals yielded no false negatives or false positives, provided the urine was obtained during the first trimester of pregnancy. These authors injected 5 cc. of the first morning urine in the dorsal or lateral lymph sac of the frog. Two or more frogs were used in each case, each frog was placed in a separate clean, dry, glass jar with a perforated lid and remained for 2 to 4 hr. at room temper ature. At the end of this time any urine that had been voided was examined microscopically. If spermatozoa were not present the urine was drained from the jar. The frog was then squeezed by hand while still in the jar. This pres sure usually induced another urination which was now examined. Robbins & Parker (6) performed a test in the same manner, except that they took cloacal smears from their animals beginnning 1 hr. after injection. They report the results on 122 urines, 10 of which were obtained from normal nonpregnant girls. In the remaining 112 urines there were 78 from known pregnancies, and 34 from patients with amenorrhea, who were determined t.o be nonpregnant by the Aschheim-Zondek or F � iedman tests. No false positive reactions were encountered, but there was one false negative on the urine of a patient who was only 2 weeks beyond her first missed period.In our own clinic (21) Rana pipiens has been used for preg-nancy tests in 1 Synonym for amphibia-more specific toads, tree toads, and frogs.

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“…Expectant treatment was championed simultaneously on both sides of the Atlantic by Macafee (1945) and Johnson (1945). Both based their treatment on the contention that in the absence of vaginal manipulation the first haemorrhage from a placenta praevia will never be fatal, and subsequent haemorrhages will not be fatal so long as the haemoglobin level of the blood is normal at the onset of bleeding.…”

Section: Recent Literaturementioning

confidence: 99%

Conservative Treatment of Placenta Praevia

Mills¹

1948

BMJ

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Placenta Praevia—A Study of 174 Cases

Cited by 82 publications

References 3 publications

Pregnancies complicated by placenta praevia: what is appropriate management?

Pregnancies complicated by placenta praevia: what is appropriate management?

Obstetrics

Conservative Treatment of Placenta Praevia

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