Objective Assess performance in diagnosis and management of placenta praevia.

Setting Tertiary referral hospital (6000 deliveries per annum)

Method Retrospective case note audit of all cases of placenta praevia at delivery over a 12 month period. Criteria and standards taken from RCOG Greentop guideline 27.

Results Twenty-eight women were included. Mean age 33 and mean parity.1 Previous history of caesarean delivery in 7 cases. At routine 20 week scanning placental localisation was documented in 93%. Follow up imaging at 32 weeks was performed in 96% (trans-abdominal 89%, trans-vaginal 7%). MRI scan was performed in 2/7 women with previous Caesarean delivery. Sixteen women (50%) were delivered by elective Caesarean section of which 8 (50%) were before 38 weeks. Ten women (36%) were delivered by emergency Caesarean section and 2 patients had normal deliveries. A Consultant Obstetrician was present for delivery in 94% of elective and 50% of emergency deliveries. Of women undergoing Caesarean section, consent for haemorrhage, transfusion and hysterectomy was 96%, 85% and 73% respectively.

Conclusion The imaging modalities of transvaginal ultrasound and MRI should be utilised more frequently in the diagnosis of placenta praevia. Consultant presence on labour ward out-of-hours would lead to enhanced supervision at emergency deliveries.