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Imaging, Categorizing Previa
I agree with Dr. Melinda M. Scully Noah that precise definitions are crucial in the management of placenta previa ("New Placenta Previa Definitions Advocated," Sept. 1, 2001, p. 14).
There should be no problem, however, in defining placenta previa nor its degree if transvaginal sonography (TVS) is used.
Experts agree that it should be the imaging technique of choice in placenta previa, as it has been consistently shown to be superior to transabdominal sonography.
TVS allows precise imaging of the cervical internal os and the lower placental edge.
Dr. L.W Oppenheimer and colleagues showed that when the lower placental edge is 2 cm or greater from the internal os, a vaginal delivery is usually possible (Am J. Obstet. Gynecol. 165[4, pt. 1]:1036-38, 1991).
Therefore, these women can safely be offered a trial of vaginal delivery. There are, however, no data to show that women with a placental edge less than 2 cm from the internal os can safely deliver vaginally.