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Placenta praevia diagnosed in the second trimester – referral and counselling
  1. K Munro,
  2. LM Page,
  3. JC Girling
  1. West Middlesex University Hospital, Isleworth, Middlesex, UK

Abstract

Introduction Maternal and fetal morbidity from placenta praevia (PP) remain a burden to health resources. The authors introduced a proforma with 15 pertinent clinical questions for use after PP is diagnosed, with the aim of improving communication and patient care.

Before proforma (n=28)After introduction of proforma (n=193)
Identification of increased risk of placenta accreta (previous Caesarean section and anterior PP)0/2811/193 (6%) 5/11 (45%) referred to consultant-led antenatal clinic
Initial discussion regarding objection to blood transfusion0/28187/193 (97%) (p<0.001) 23/187 (12%) would decline blood transfusion
4/23 (17%) referred to consultant-led antenatal clinic
Counselling regarding avoiding sexual intercourse and travel, and immediate presentation to hospital if bleeding vaginally1/28 (4%)82/193 (42%) (p<0.001

Method Women with PP at the midtrimester anomaly scan were prospectively identified over 11 months (2008–2009) by the ultrasound department (USD) and referred to the Day Assessment Unit for counselling and completion of the proforma. During the first 3 months of proforma use, hospital numbers of women attending for third trimester placental localization scans (who had their anomaly scans prior to introduction of the proforma) were noted by USD (control group). Retrospective review of counselling proformas, medical case notes and computer records was performed.

Results The authors identified 221 consecutive cases of PP. Fisher's exact used to compare groups.

Conclusion Referral pathways have been enhanced by the introduction of a proforma, as has effective counselling of women diagnosed with PP, although there is scope for further improvement. Advance information for women attending anomaly scans of the potential requirement for additional discussion may promote compliance and reduce potential maternal anxiety.

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