Placenta Praevia: Does Uterine Activity Cause Bleeding?

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Abstract
EDITORIAL COMMENT": We accepted this paper for publication since it attempts to evaluate whether uterine contractions or ‘taking‐up’ of the lower uterine segment initiate placental separation and haemorrhage in women with central placenta praevia. Obstetric practice in the USA is often different from that in Australia; certainly it is not our custom to manage women at home when central placenta praevia complicated by haemorrhage has occurred after the second trimester! The use of tocolysis for preterm labour in women with placenta praevia with or without haemorrhage is another regimen employed in this series that will interest readers. Summary: Twenty‐two women >24 weeks' gestation with a central placenta praevia were monitored to determine if an increase in uterine activity precedes bleeding in patients with central praevias. Monitoring of all subjects began at 26.3 ±4.4 weeks and continued until 37 weeks (or delivery if preterm). All subjects had at least one haemorrhage, 7 women had 2, and 4 subjects had 3 episodes of bleeding. Only 3 patients delivered at term while the remainder (86%) delivered preterm. The gestational age at first episode of bleeding was 29.1 ±3.6 weeks and at delivery was 34.3 ±3.3 weeks. Nine women (41%) had an increase in uterine activity above baseline the day of or the day preceding the first haemorrhage. The increase in uterine activity was not statistically significant when compared to the 6 days prior to bleeding when all 22 patients were considered.

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