Ultrasound Exam for Suspected Placenta Previa

Ultrasound is highly sensitive in detecting placenta previa, but a significant number of false-positive examinations occur. Since the consequences of placenta previa are so serious, it is important not to underdiagnose the condition. The standard examination for placenta previa uses TAS and a longitudinal projection with a full urinary bladder. In order to rule out placenta previa, the cervical os must be clearly visualized and must be free of overlying placenta. Visualization of the placenta at a site distant from the os makes previa unlikely but does not rule it out, since an accessory placental lobe may also be present. When the relationship between the internal cervical os and the placenta cannot be clearly established using the standard examination, other sonographic approaches may be attempted. Traction on the fetal head with the patient in the Trendelenburg position may allow an improved view of the cervical os in late pregnancy. Completely emptying the urinary bladder may improve transabdominal images of the cervical os in some cases. Transvaginal sonography gives better visualization of the cervix and is preferred in patients who have not had vaginal bleeding. The theoretical risk of dislodging clots and causing significant bleeding by introducing a probe into the vagina has led some clinicians to use transperineal sonography instead. Transperineal sonography is performed by placing the abdominal transducer on the perineum between the urethra and the vagina. This method has been found to be very accurate for diagnosing placenta previa.18

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