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Capping placenta. A new etiologic factor in midtrimester bleeding
The results of an echographic study to determine the causal factors in 63 consecutive cases of second-trimester bleeding are presented. True second-trimester bleeding is uncommon (0.8% of pregnancies during the study period), but the impact on fetal outcome is serious because the condition is associated with late abortion, preterm intra-uterine demise, preterm birth, and neurologic sequelae. Various placental structural anomalies occurred in 8% of our cases, and another 8% showed marginal solution of the placenta. In 6% there was retro-amniotic bleeding, whereas placenta praevia was seen in only 3%. The prevailing placental localization (27%) found in patients with second-trimester hemorrhage was a peculiar one in that the placenta literally "capped" the lateral as well as the anterior and posterior walls of the uterine cavity, while the lower margin failed to reach the isthmic region. This type of placentation, which we call capping placenta, occurs in only 2.6% of normal pregnancies. The implication of the findings are discussed.
The results of an echographic study to determine the causal factors in 63 consecutive cases of second-trimester bleeding are presented. True second-trimester bleeding is uncommon (0.8% of pregnancies during the study period), but the impact on fetal outcome is serious because the condition is associated with late abortion, preterm intra-uterine demise, preterm birth, and neurologic sequelae. Various placental structural anomalies occurred in 8% of our cases, and another 8% showed marginal solution of the placenta. In 6% there was retro-amniotic bleeding, whereas placenta praevia was seen in only 3%. The prevailing placental localization (27%) found in patients with second-trimester hemorrhage was a peculiar one in that the placenta literally "capped" the lateral as well as the anterior and posterior walls of the uterine cavity, while the lower margin failed to reach the isthmic region. This type of placentation, which we call capping placenta, occurs in only 2.6% of normal pregnancies. The implication of the findings are discussed.