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Objective: To evaluate whether vasa previa at delivery is associated with a history of second-trimester placenta previa., Study Design: Retrospective, case-control study of all vasa previa cases at Good Samaritan Regional Medical Center from January 1, 1991, to May 1, 2001. Cases were identified by ICD-9 codes and confirmed by chart review. Each case was matched in a 1:4 ratio with controls based upon normal placentation at delivery, ultrasound documentation of midtrimester placental location, maternal parity and gestational age at delivery., Results: During the study period, 13 cases of vasa previa were identified. Nine cases (9/13, 69.2%) of vasa previa at delivery had a second-trimester placenta previa as documented by midtrimester ultrasonography, whereas 2 controls (2/52, 3.8%) had a second-trimester placenta previa (P < .000001, OR = 56.3, 95% CI = 8.9-354.1)., Conclusion: There is a highly significant association between vasa previa at delivery and a history of second-trimester placenta previa.

Maternal serum alpha-fetoprotein (MSAFP) is a regularly utilized antenatal screening test for the identification of pregnancies at increased risk for a variety of genetic and nongenetic abnormalities. Complete mid-trimester evaluation of the patient with a positive screening test may fail to reveal an etiology for a positive MSAFP value. This case report concerns an unexplained positive/elevated MSAFP screening test for a patient found at delivery to have abnormal placentation.

Transfusion-mediated cytomegalovirus (CMV) infection among neonates and nonpregnant, adult female surgical patients has been described thoroughly. A case of symptomatic congenital CMV infection developed after a maternal transfusion during pregnancy. It is estimated that 2.5-12.5% of individual blood units mediate CMV infection though inadvertent transfusion of CMV-infected leukocytes. The use of CMV-seronegative or deglycerolized blood may eliminate or considerably reduce the risk of transfusion-mediated primary CMV infection in pregnant women and their fetuses. CMV-seronegative or deglycerolized blood is used routinely in the case of CMV-susceptible neonates and immunocompromised individuals who require a transfusion. Whenever possible, CMV-seronegative or deglycerolized blood should be used for transfusions in pregnant women who are CMV seronegative or whose serologic status is unknown.

Continuous-wave Doppler studies of the umbilical arteries were performed on 100 women with placenta previa prior to delivery in the third trimester and 100 control subjects matched for gestational age and with normally implanted placentas. The ratio of the maximum (systole [S]) and minimum (diastole [D]) velocities appeared to reflect downstream vascular resistance. An S:D ratio of greater than or equal to 3.0 indicated elevation. There was a statistically higher S:D ratio in the placenta previa group as compared to the control group, and that difference persisted even when growth-retarded fetuses were excluded from both groups. Placenta previa patients with S:D ratios greater than or equal to 3.0 were associated with a statistically higher incidence of adverse pregnancy outcomes. The sensitivity, specificity, and positive and negative predictive value of an elevated S:D ratio in predicting adverse pregnancy outcomes were 90.0%, 93.8%, 62.0% and 98.5%, respectively. Our data suggest that (1) placenta previa patients are at increased risk of intrauterine growth retardation and adverse pregnancy outcomes, (2) placenta previa patients with normal S:D ratios are at no greater risk of adverse outcomes than are controls, (3) when the S:D ratio is elevated in placenta previa patients, it is more likely to be associated with adverse pregnancy outcomes, and (4) placenta previa patients without growth failure have a higher S:D ratio than do those with normally implanted placentas. Umbilical artery velocimetry appears to be a useful adjunct to ultrasound in the surveillance of pregnancies complicated by placenta previa.

The May-Hegglin anomaly is a rare autosomal dominant platelet disorder that can be associated with significant bleeding. We treated a patient for pregnancy complicated by the May-Hegglin anomaly and a complete placenta previa.

Six patients with placenta previa complicated by premature labor underwent tocolysis with terbutaline sulfate. The average prolongation of pregnancy was 3.5 weeks. Five patients were at 31 weeks' gestation or more at the initiation of tocolytic therapy and had infants who survived and were greater than 2,000 gm at birth. All patients received an average blood transfusion of 6.7 units of packed cells each.