Placental disorders such as placenta previa, placenta accreta, and vasa previa are all associated with vaginal bleeding in the second half of pregnancy. They are also important causes of serious fetal and maternal morbidity and even mortality. Moreover, the rates of previa and accreta are increasing, probably as a result of increasing rates of cesarean delivery, maternal age, and assisted reproductive technology. The routine use of obstetric ultrasonography as well as improving ultrasonographic technology allows for the antenatal diagnosis of these conditions. In turn, antenatal diagnosis facilitates optimal obstetric management. This review emphasizes an evidence-based approach to the clinical management of pregnancies with these conditions as well as highlights important knowledge gaps.
Evidence-based recommendations for the diagnosis and management of placenta previa, vasa previa, and placenta accreta are presented.
University of Utah School of Medicine, Salt Lake City, Utah.
Correspondence: Robert M. Silver, MD, Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 North 1900 East, Room 2B308, Salt Lake City, UT 84132; e-mail: firstname.lastname@example.org.
Financial Disclosure The author did not report any potential conflicts of interest.
The author thanks Susan Fox for assistance in the technical preparation of the manuscript and Anne Kennedy, MD, and Paula Woodward, MD, for assistance with the figures.
Continuing medical education for this article is available at http://links.lww.com/AOG/A672.