Does a diagnosis of morbidity adherent placenta using imaging techniques lead to improved outcomes in pregnant women with a previous caesarean section currently diagnosed with placenta praevia?

DetailsAdditional comments
Review questionDoes a diagnosis of morbidly adherent placenta using imaging techniques lead to improved outcomes in pregnant women with a previous CS currently diagnosed with placenta praevia?Question to follow on from diagnostic accuracy question.
ObjectivesTo assess the impact on outcomes of having a diagnosis of morbidly adherent placenta prior to birth currently diagnosed with placenta praevia compared with outcomes where there has been no antenatal diagnosis.
LanguageEnglish
Study designComparative observational studies (cohort, case control studies for diagnosed vs. undiagnosed morbidly adherent placenta)
Comparative observational studies for different interventions
StatusPublished papers
PopulationPregnant women with a previous CS currently diagnosed with placenta praeviaPopulation includes:
In-vitro fertilization conceptions
Advanced maternal age
Multiparity
Previous uterine curettage
Specific considerations:
Women with raised BMI
InterventionDiagnosis of morbidly adherent placenta using imaging techniques followed by any preparation/intervention for managing morbidly adherent placentaThird-trimester scan
Forward planning for care of women with diagnosed morbidly adherent placenta eg. Vascular surgeon present/senior anaesthetist present, availability of high dependency care for woman, blood products ready for transfusion etc. GDG to list key components.

Does knowing answer to MRI or colour-flow ultrasound make difference to actual outcome?
ComparatorEmergency intervention in unexpected cases of morbidly adherent placentaWhere possible we may be able to compare different interventions for managing morbidly adherent placenta (depending on quality of the evidence).
OutcomesMaternal outcomes
Maternal mortality
Maternal morbidity:
Post partum haemorrhage (haemorrhage >1000 ml, low postnatal haemoglobin/anaemia, need for blood transfusion (see other question for agreed composite for PPH)
Hysterectomy
Uterine rupture or dehiscence
Bladder injury
High dependency/intensive care admission/length of stay
Maternal views/experience of care (“satisfaction”)

Neonatal outcomes
Neonatal mortality
NICU admission
Other criteria for inclusion/ exclusion of studiesExclude non-human studies
Case series
Exclude non-English papers
Exclude studies carried out in resource poor/developing countries
Review strategiesStudies will be assessed for study quality according to the process described in the NICE guidelines manual (January 2009)
A list of excluded studies will be provided following weeding
Evidence tables and an evidence profile will be used to summarise the evidence

From: Appendix D, Review protocols

Cover of Caesarean Section
Caesarean Section.
NICE Clinical Guidelines, No. 132.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2011 Nov.
Copyright © 2011, National Collaborating Centre for Women's and Children's Health.

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