Placenta Praevia : management in the last century

Abstract

Placenta praevia is nowadays managed by Caesarean section in most cases, and only in the marginal or lateral placenta praevia is vaginal delivery considered. The situation was very much diHerent in the past, when the mortality associated with the operation prohibited the use of Caesarean section in the management of placentae praevia. The maternal mortality following section in 1888 was reported (8) at 54-62%, while that following complications of placenta praevia was lower at 30% (17). The parental mortality following vaginal delivery in cases of placerta praevia was 50-74% (7). Caesarean section for placenta praevia was recommended in 1898 by Lawson Tait (9) but acceptance only gained ground slowly. In 1923, it was noted (5) that "the performance of Caesarean section for cases of placenta praevia .... is being overdone." As late as 1951 (1) Caesarean section was noted to be contra-indicated if the patient had been examined vaginally in her home, or after a pack had been inserted in to the vagina, or if the child was too premature. It was considered the method of choice in elderly primi- gravida, total placenta praevia and in those cases of partial placenta praevia in which the cervix was long and closed. The reduction in foetal mortality was only brought about after Macafee 01,12) introduced the con- servative antenatal management of placenta praevia with the aim of allowing the pregnancy to continue until the fetus has a chance of survival ex utero.