Sonographic Parameters and Risk of Antepartum Hemorrhage in Asymptomatic Women With Placenta Previa: A Cohort Study

Study Overview
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Brief Summary
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The aim of this study is to evaluate the effectiveness of ultrasonographic parameters (cervical length, placental thickness and distance placental edge from internal os of the cervix) in predicting the risk of antepartum hemorrhage and emergency cesarean delivery in asymptomatic women with placenta previa.

Detailed Description
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The incidence of placenta previa is 3-5 per 1000 pregnancies worldwide and is still rising because of increased maternal age, parity, cesarean section rates, assisted reproductive technology, maternal smoking with the widespread use of transvaginal ultrasound. antepartum hemorrhage is an important cause of maternal and neonatal morbidity and mortality in pregnant women with placenta previa. However, the epidemiological characteristics are not completely understood. this study aims at evaluating the sonographic findings in asymptomatic women with placenta previa as cervical length, placenta thickness and distance from cervix to placental edge to recommend management for in-patients versus out-patient antenatal care and early planned hospital admission and delivery for women at high risk of antepartum hemorrhage and preterm cesarean section and hysterectomy for life threatening antepartum hemorrhage.

Official Title
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Sonographic Parameters and Risk of Antepartum Hemorrhage in Asymptomatic Women With Placenta Previa: A Cohort Study

Conditions
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Placenta Previa

Intervention / Treatment
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* Diagnostic Test: Ultrasonographic parameters


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Asymptomatic women diagnosed with placenta previa according to RCOG (GTG No. 27a, 2018): placenta lies directly over the internal os for pregnancies more than 16 weeks' gestation on transabdominal or transvaginal scanning. Gestational age between 28 till 37 weeks' gestation (as delivery should be considered between 36 and 37 weeks of gestation for women presenting with uncomplicated placenta previa) Exclusion Criteria: Multiple pregnancies. Threatened preterm labor or preterm rupture of membranes. History of bleeding in the current pregnancy. Polyhydraminos (AFI > 25 cm). History of cervical surgery (cone biopsy). Presence of cervical cerclage. Maternal use of vaginla progesterone. History of maternal disease (hypertensive, DM, Cardiac). Fetal malformation or growth restriction
Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Diagnostic Test: Ultrasonographic parameters|cervical length. placental thickness. distance placental edge from internal os of the cervix|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| maternal bleeding rate | number of attacks of antepartum hemorrhage | till delivery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Blood transfusion | number of PRBCs | till delivery 36 to 37 weeks | 
| Emergency Cesarean section | severe antepartum hemorrhage requiring delivery | till delivery 36 to 37 weeks | 
| Premature delivery | before the planned delivery date (before 37 weeks' gestation) | 37 week's gestation | 
| Need for cesarean hysterectomy | cesarean hysterectomy due to bleeding or placenta accreta spectrum | during cesarean section | 
| Postpartum hemorrhage | severity of attacks and required further management or blood transfusion | Within 2 hours of delivery |