Störungen der Plazentation und Nabelschnurinsertion

Key words

placenta - ultrasound - obstetrics

Kernaussagen

• Nicht jede im ersten Trimenon festgestellte Placenta praevia persistiert bis zum Termin. Das Risiko einer Persistenz ist abhängig vom Gestationsalter sowie dem Grad der Überlappung des inneren Muttermundes!

• Bei Placenta praevia ist eine genaue sonografische Dokumentation und Berücksichtigung der Wandlokalisation wichtig!

• Bei Placenta praevia oder Schwangeren mit Uterusvoroperationen sollte die Implantationstiefe der Plazenta sonografisch untersucht werden!

• Bei tiefer Plazentaimplantation ist ein konservatives Management mit Belassen der Placenta in utero möglich!

• Bei allen Schwangeren, insbesondere bei Schwangeren mit Placenta praevia oder Implantationsstörungen sowie bei Feten mit singulärer Nabelschnurarterie sollte der Nabelschnuransatz untersucht werden, um Vasa praevia auszuschließen!

• Bei Vasa praevia ist eine Hospitalisation im dritten Trimenon zu empfehlen und wie bei Placenta praevia eine primäre Sectio caesarea zwingend!

Main statements

• Not every case of placenta previa identified in the first trimester persists to the time of delivery. The risk of persistence depends on the gestational age and the degree of overlapping of the internal cervical os.

• Exact sonographic documentation and consideration of the wall location are important for placenta previa.

• The implantation depth of the placenta should be sonographically examined in the case of placenta previa or pregnancies with previous uterus operations.

• In the case of deep placenta implantation, conservative management without removal of the placenta is possible.

• The umbilical cord insertion should be examined in all pregnant women, in particular in those with placenta previa or implantation disorders, and in fetuses with a single umbilical artery in order to rule out vasa previa.

• Hospitalization in the third trimester is recommended for vasa previa and a primary cesarean section is absolutely necessary as in the case of placenta previa.

Literatur/References

• 1 Oyelese Y, Smulian J C. Placenta previa, placenta accreta, and vasa previa.  Obstet Gynecol. 2006;  107 927-941
• 2 Becker R H, Vonk R, Mende B C. et al . The relevance of placental location at 20 - 23 gestational weeks for prediction of placenta previa at delivery: evaluation of 8650 cases.  Ultrasound Obstet Gynecol. 2001;  17 496-501
• 3 Faiz A S, Ananth C V. Etiology and risk factors for placenta previa: an overview and meta-analysis of observational studies.  J Matern Fetal Neonatal Med. 2003;  13 175-179
• 4 Clark S L, Koonings P P, Phelan J P. Placenta previa/accreta and prior cesarean section.  Obstet Gynecol. 1985;  66 89-92
• 5 Ananth C V, Demissie K, Smulian J C. et al . Placenta previa in singleton and twin births in the United States, 1989 through 1998: A comparison of risk factor profiles and associated conditions.  Am J Obstet Gynecol. 2003;  188 275-281
• 6 Demissie K, Breckenridge M B, Joseph L. et al . Placenta previa: preponderance of male sex at birth.  Am J Epidemiol. 1999;  149 824-830
• 7 McShane P M, Heyl P S, Epstein M F. Maternal and perinatal morbidity resulting from placenta previa.  Obstet Gynecol. 1985;  65 176-182
• 8 Gemer O, Segal S. Incidence and contribution of predisposing factors to transverse lie presentation.  Int J Gynaecol Obstet. 1994;  44 219-221
• 9 Heer I M, Muller-Egloff S, Strauss A. Placenta praevia - comparison of four sonographic modalities.  Ultraschall in Med. 2006;  27 355-359
• 10 Timor-Tritsch I E, Monteagudo A. Diagnosis of placenta previa by transvaginal sonography.  Ann Med. 1993;  25 279-283
• 11 Tikkanen M, Nuutila M, Hiilesmaa V. et al . Clinical presentation and risk factors of placental abruption.  Acta Obstet Gynecol Scand. 2006;  85 700-705
• 12 Cotton D B, Read J A, Paul R H. et al . The conservative aggressive management of placenta previa.  Am J Obstet Gynecol. 1980;  137 687-695
• 13 Wing D A, Paul R H, Millar L K. Management of the symptomatic placenta previa: a randomized, controlled trial of inpatient versus outpatient expectant management.  Am J Obstet Gynecol. 1996;  175 806-811
• 14 Bhide A, Prefumo F, Moore J. et al . Placental edge to internal os distance in the late third trimester and mode of delivery in placenta praevia.  BJOG. 2003;  110 860-864
• 15 Clark S L. Placenta previa and abruptio placentae. Creasy RK, Resnik R Maternal Fetal Medicine: Principles and Practice Philadelphia; WB Saunders 1999: 616
• 16 Crane J M, Hof M C, Dodds van den L. et al . Neonatal outcomes with placenta previa.  Obstet Gynecol. 1999;  93 541-544
• 17 Lavery J P. Placenta previa.  Clin Obstet Gynecol. 1990;  33 414-421
• 18 Timmermans S, Hof A C, Duvekot J J. Conservative management of abnormally invasive placentation.  Obstet Gynecol Surv. 2007;  62 529-539
• 19 Comstock C H. Antenatal diagnosis of placenta accreta: a review.  Ultrasound Obstet Gynecol. 2005;  26 89-96
• 20 Krapp van M, Axt-Fliedner R, Berg C. et al . Clinical application of grey scale and colour Doppler sonography during abnormal third stage of labour.  Ultraschall in Med. 2007;  28 63-66
• 21 O’Brien J M, Barton J R, Donaldson E S. The management of placenta percreta: conservative and operative strategies.  Am J Obstet Gynecol. 1996;  175 1632-1638
• 22 Bodner L J, Nosher J L, Gribbin C. et al . Balloon-assisted occlusion of the internal iliac arteries in patients withplacenta accreta/percreta.  Cardiovasc Intervent Radiol. 2006;  29 354-361
• 23 Catanzarite V, Maida C, Thomas W. et al . Prenatal sonographic diagnosis of vasa previa: ultrasound findings and obstetric outcome in ten cases.  Ultrasound Obstet Gynecol. 2001;  18 109-115
• 24 Francois K, Mayer S, Harris C. et al . Association of vasa previa at delivery with a history of second-trimester placenta previa.  J Reprod Med. 2003;  48 771-774
• 25 Lee W, Lee V L, Kirk J S. et al . Vasa previa: prenatal diagnosis, natural evolution, and clinical outcome.  Obstet Gynecol. 2000;  95 572-576
• 26 Oyelese Y, Spong C, Fernandez M A. et al . Second trimester low-lying placenta and in-vitro fertilization? Exclude vasa previa.  J Matern Fetal Med. 2000;  9 370-372
• 27 Kouyoumdjian A. Velamentous insertion of the umbilical cord.  Obstet Gynecol. 1980;  56 737-742
• 28 Raio L, Saile G, Brühwiler H. Discordant umbilical cord arteries: prenatal diagnosis and significance.  Ultraschall in Med. 1997;  18 229-232
• 29 Sepulveda W, Rojas I, Robert J A. et al . Prenatal detection of velamentous insertion of the umbilical cord: a prospective color Doppler ultrasound study.  Ultrasound Obstet Gynecol. 2003;  21 564-569
• 30 Oyelese Y, Catanzarite V, Prefumo F. et al . Vasa previa: the impact of prenatal diagnosis on outcomes.  Obstet Gynecol. 2004;  103 937-942
• 31 Oyelese Y, Smulian J C. Placenta previa, placenta accreta, and vasa previa.  Obstet Gynecol. 2006;  107 927-941