Prevalence Of Antepartum Hemorrhage In Women With Placenta Previa: Fill & Download for Free

Hi. I was interested in this question because of a recent diagnosis at 20 weeks of marginal to partial placenta previa myself. I found most internet resources and answers to be unhelpful. Therefore, I did some research through my university and on google scholar. A bit about my situation… I’m 36 and carrying a boy (2 risk factors) but have never had a child before (lowering my risk) and am not a current smoker or cocaine user (also lowering my risk of the condition persisting). I’m not a doctor, but do like to read research to get an informed picture and reassurance.Here is what I was able to find (with citations, so you can look the information up yourself if you are interested in another specific group). I particularly found the Dashe, et al. paper helpful. The doi is listed below:Placenta Previa Lit. ReviewHow common is it?4.4 out of every 1000 births in the U.S.Risk factors I have include male fetus and advanced maternal age. I can rule out smoking, cocaine use, having twins, and a previous c-section.A problem most studies are likely to have is that other risk factors include smoking and doing cocaine. Those seem like they would be risk factors for a whole bunch of issues, and therefore outcomes may look worse for the pregnancies as a whole, than they would for someone with placenta previa who isn’t a practicing smoker and drug addict…Potential complications in the population with previa at birth(Rosenburg, et al., 2010):peripartum hysterectomy (removal of uterus): 5.3% of casessecond trimester bleeding (most bleeding is usually in the third trimester): 3.9% of casesneed for blood transfusion: 21.9% of casesmaternal sepsis: 0.4% of casesvasa previa (baby’s blood vessels cross the opening to the uterus, risking rupture at delivery, which can cause fetal death from loss of blood): 0.5%Malpresentation: 19.8% of casesDead baby (stillbirth or otherwise): 6.6%Apgar score of less than 7/10: 25.3% (this doesn’t predict much, but 0-3 is predictive of dead babies or cerebral palsy)Congenital malformations: 11.5%Growth restriction: 3.6%The biggest concern is antepartum hemorrhage (excessive bleeding after 20 weeks but before birth…most likely in third trimester): 51.6% (this is 10 xs higher than the general pregnant population): Fan, et al., 2017.-Higher in North America: 53.2%-This has been improving over time. Worse in 1980 (near 80%), less bad in 2010 (near 40%)-mortality rate for mom in the U.S. is 0.03% due to bleeding (Almnabri, et al., 2017)-Bleeding occurs in 33.7% of women prior to 30 weeks (this seems to contradict previous meta-analysis: Rosenburg et al, 2010)-44.6% bleed after 30 weeks-21.7% have no bleeding-50% of women who did have bleeding, did not deliver for 4 weeks (Lockwood, et al. 2018)-Even with profuse bleeding of more than 500 ml and/or requiring transfusion, women still didn’t give birth for 17 days on average.Concerns for the baby related to pre-term delivery with previa:Preterm delivery (according to Almnabri, 2017): is 44% for before 37 weeksOne indication this will be a problem is cervical length (Sotiriadis, et al., 2009).-Average cervical length is 3.5 cm at 24 weeks.-Less than 2.2 cm = 20% chance of preterm labor.-1.5 cm or less is a 50% chance of pre-term.Is the baby likely to be ok if born early?Babies born at 24 weeks have a 50% chance of survival, and of the survivors, 25% have severe neurodevelopmental problems.Babies born at 30 weeks have an 8-10% chance of death or developmental disabilityBabies born at 34 weeks have a risk of 0.4%-5% for death or disabilityBefore 32 weeks is considered very-pretermResearchers found it was unlikely to go into preterm if the cervix is greater than 15 mm (test is normal) before 34 weeks (96% not going into labor is good). There is this caveat in the article that I don’t understand (feel free to explain in the comments section if you do):One should always be cautious when interpreting NPVs, as they are so strongly dependent on the prevalence of the condition of interest that even a test with no diagnostic value (i.e. sensitivity 50% and specificity 50%) would yield an NPV of 95% if the prevalence of the condition is 5%. Therefore, NPVs should be interpreted only in their broad sense or they should be used for providing a means of comparison between different predictive methods for a given prevalence of the condition of interest. Given these limitations, testing with cervical length measurement still appears to assist rationalizing clinical management, provided that the clinician interprets the results appropriately.What should I expect during the rest of my pregnancy after being diagnosed with placenta previa?Follow-up care after initial diagnosis:32 week ultrasound: see if the placenta has moved up as the uterus expands, so that it is no longer covering the cervix.-rule out vasa previa using doppler scan to make sure baby won’t rupture vessels if born vaginally-if placenta is still <2 cm from the cervix opening, follow up at 36 weeks with another ultrasound36 week follow up: If still an issue, C-section is scheduledThis question was particular to my situation…How likely is it that marginal or partial placenta previa at 20 weeks will resolve?34% persistent until delivery if found at 20 weeks (but less likely because it’s marginal, not complete…Dashe, et al., 2002, doi:10.1016/s0029-7844(02)01935-x). Previa was twice as likely to persist if it was complete rather than incomplete.At 24-27 weeks if it’s still there, it’s likely to persist at 49% (another study found this to be 57% with any degree of previa, partial or complete, Lauria, et al.)28-31 weeks 62%32-35 weeks 73%Previa before 20 weeks persists in only 10% of cases.This study broke these numbers into further groups that are useful. I would be considered a nulliparous woman (haven’t borne children before). Previa at 20 weeks for this group persists in only 11-12% of cases.The groups where the rate dips the most are those who’ve had kids before. Women with complete previa and c-section had the highest risk.