![]() ![]() In particular, evidence suggests that these women might still present an increased risk of postpartum haemorrhage compared with women with a normally located placenta since the second trimester scan. 16 In addition, the Canadian guideline includes the possibility of a trial of labour (TOL) in women with an IOD ≤10 mm if no other risk factors, such as previous bleeding episodes 5 mm compared with 20 mm, during the third trimester. Conversely, the 2015 Dutch and the 2020 Canadian guidelines have suggested that a vaginal birth should be offered to all women with low-lying placenta and an IOD between 11 and 20 mm, since the likelihood of an emergency CS due to haemorrhage is low. 9–14 Recently, both the American and the Royal College of Obstetrics and Gynecology 5 15 have stated that for women with a third trimester asymptomatic low-lying placenta, mode of birth should be individualised based on the clinical background and the woman’s preference. While there is consensus that caesarean section (CS) should be performed in case of placenta praevia, the most appropriate mode of birth in women with low-lying placenta is still controversial due to lack of robust data. 6 7 Knowledge of the IOD is crucial for choosing the most appropriate mode of birth. 4 The optimal timing for such measurement is suggested to be the late third trimester, that is, 36 weeks’ gestation, 5 since the lower uterine segment has mostly formed at this time. Transvaginal scanning (TVS) is the gold-standard technique for measuring the distance between the placental edge and the internal os of the cervix, the internal-os-distance (IOD). ![]() The term placenta praevia identifies a placenta that covers completely the internal os of the uterine cervix, while the term low-lying placenta is used to define a placenta that is partially implanted in the lower uterine segment with the inferior placental edge located at 1–20 mm from the internal cervical os. ![]()
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