Low-lying placenta is defined as an internal os distance (IOD) between 0-20 mm
There are conflicting guidelines on the preferred mode of delivery
While there is a risk of bleeding and emergent cesarean delivery, some women will delivery vaginally
Benefit of cesarean section remains unproven
Jansen et alsought to determine the probability of a successful vaginal delivery with a low-lying placenta
METHODS:
Systematic review and meta-analysis
Two independent reviewers
Eligible studies: (1) Vaginal delivery in patients with a low-lying placenta in the third trimester and/or (2) Morbidity related to mode of delivery in patients with a low-lying placenta in the third trimester was described
Prospective and retrospective cohort studies | Case-control studies | Case series with >10 cases | Conference abstracts with author contact
Distinguished between IODs
>20 | 0–20 | 11–20 | 0–10 mm
Primary outcome
proportion of women with a low-lying placenta and a successful vaginal delivery and no emergency cesarean due to hemorrhage
Secondary outcomes
Maternal morbidity including
Antepartum and postpartum blood loss | Blood transfusion
Cesarean section rates due to hemorrhage
CONCLUSION:
Low-lying placenta does not require a cesarean section, although there is a higher risk of emergency cesarean section
Even at 0 to 10mm, morbidity was not increased compared to >10mm
The authors state
Therefore, women with a low-lying placenta having an IOD between 0 and 20 mm can have a trial of labour in a clinical setting after in-depth counselling and shared decision making
low-lying placenta c-section date?
