بسم هللا الرحمن الرحيم

The National Ribat University

Faculty of graduate studies and scientific research

Common Position of the Placenta in the Second Trimester

of the Pregnancy among Sudanese Women in Khartoum

state

A thesis submitted in partial fulfillment required for MSc

degree in Clinical Anatomy

By:

Nahla Mohammed Elhadi Ali

Supervisor:

Dr. Kamal Eldin Elbadawi Babiker

2014

حـ حيى ثسى للا انش انش

رشاة ي ﴿ انجعث فإب خهقبكى ي زى في سيت ي ك ب أيب انبط إ

غيش يخهقخ نجي يضغخ يخهقخ عهقخ ثى ي طفخ ثى ي ثى ي

قش في األسحبو يب ش ثى خشخكى طفال ثى نكى بء إن أخم يس

ش يشد إن أسرل انع كى ي ي ف يز كى ي ي كى نزجهغا أشذ

رش األسض بيذح فإرا أضنب عهي ثعذ عهى شيئب ب نكيال يعهى ي

يح ج ث كم ص جزذ ي أ سثذ د زض بء ا ﴾ ان

(5رقم ) االية الحج سورة

Acknowledgement

I would like to express my gratitude to my supervisor DDrr..KKaammaall EEllddiinn

EEllbbaaddaawwii BBaabbiikkeerr ffoorr hhiiss hheellpp,, ssuuppppoorrtt,, encouragement, invaluable

advice and untiring efforts through all stages of this study. Without

him this couldn't be accomplished. My deep gratitude to PPrrooffeessssoorr

AAllttaahhiirr OOtthhmmaann ffoorr hhiiss eennccoouurraaggeemmeenntt aanndd wwiiddee ssuuppppoorrtt.. I would like

to thank everyone who assisted me in this research. Finally, with great

appreciation I would like to thank my family members for their

patience and sincere support.

DDeeddiiccaattiioonn

II wwoouulldd lliikkee ttoo ddeeddiiccaattee tthhiiss rreesseeaarrcchh ttoo::--

My parents….

My grandmothers ….

My brothers and sisters….

My relatives…..

My colleagues in all levels of education….

MMyy tteeaacchheerrss tthhrroouugghhoouutt mmyy lliiffee…..

My supervisors…..

الدراسة صلمستخ

أخشيذ ز انذساسخ انصفيخ انعشضيخ عهي انسبء انسدايبد انحايم انهاري

في قسى انخبد انصريخ نهحم ثبء انزبثعبد انذسيخ أخضع نفحص انخبد انصريخ

و دسيب. أيسزشف انصذاقخ او دسيب يسزشفي انقبثالد ،ثسزشف انششطخ

نزحذيذ ربثيش انقع ، يخقع انشبئع نهشأذاف ز انذساسخ في إقشاسان رزهخص

ثي فصبئم انذو انخزهفخ يقع سرجبط إلى ايقير انشيي عهي انقع انديي في انشحى

كب انقع ، حبيم يشاحإ 901 . رضذ ز انذساسفي انثهث انثبي ي انحم انشيخ

(74.4)% 25يبييخ خذ في ألانشيخ افي انثهث انثبي ي انحم انشبئع نهشيخ

ي.

حأيش( إ10.9)% 11في انثهث انثبي ي انحم في سي نهديأانزقذيى انش ذخ

انزقذيى (72.1يشيخ عهيب أيبييخ )% نذيكثش شيعب في انسبء انالري أ حبيم كب

في حي خذ ، يخفضخيشيخ نذي كب غيش يخد في انسبء انالري سي نهدي أانش

نذي كثش شيعب في انسبء انالري أ ي كب سبء( 1.5)% 90انعقجي نهدي في انزقذيى

نذي يشيخ عهيب قم في انسبء انالري أانعقجي نهدي انزقذيى (4.7)% يشيخ يخفضخ

في حي نى رخذ سبء نذي نى رخذ سبء كبذ نذي يشيخ قيخ أخخ ثزقذيى عقجي ،

( إيشأح حبيم71.2)% 27في انذو ) ا انخجخ( فصيهخ خذد أخخ ثزقذيى يسزعشض.

في حي خذد فصيهخ انذو ) راد انشيخ األيبييخ ، انحايم كثششيعب في انسبءكب أ

راد ايم ( إيشأح حبيم كب أكثششيعب في انسبء انح51.7)% 25أنف انخجخ( في

( إيشأح حبيم كبذ 99.1)% 92في خذد فصيهخ انذو ) ة انخجخ ( انشيخ انخهفيخ،

فصيهخ انذو خذدراد انشيخ األيبييخ أ انقيخ، في حي انحايم كثش شيعب في انسبءأ

راد انشيخ كثش شيعب في انسبء كبذ أ ( إيشأح حبيم 1.5)% 90في ) أ ة انخجخ(

نخهفيخ. ا

AAbbssttrraacctt

This descriptive cross-sectional study was done on Sudanese

109 women who did ultrasound examination for antenatal follow up in

the second trimester in Police hospital, Friendship hospital Omdurman

and Maternaty hospital Omdurman.

The objectives were to determine the commonest position of the

placenta in the second trimester, to determine the influence of

placental location on the fetal position in the uterus in the second

trimester and to assess association between different blood groups and

location of placenta in the second trimester.

The commonest position of placenta in the second trimester was

anterior placenta and found in 52 (47.7%) women, the cephalic

presentation of the fetus in the second trimester was found in 99

(90.8%) women. Most of those women had upper anterior placenta

(45.9%) but cephalic presentation was not found in women who had

low lying placenta. Breech presentation was found in 10 (9.2%)

women, most of those women had low lying placenta (6.4%) but it

was not found in women who had fundal placenta. No women had

fetus with transverse presentation. Fifty four (49.5%) women had

blood group O+ve with anterior placenta, while 32 (29.4%) women

had blood group A+ve with posterior placenta, 13 (11.9%) women

had blood group B+ve with a fundal or anterior placenta while 10

(9.2%) women had blood group AB+ve with posterior placenta.

Abbreviations

DF Degree of Freedom

Fig Figure

SPSS Statistical Package for the Social Sciences

U/S Ultrasonography

List of figures

Figure Title Page

Fig 4-1 PPllaacceennttaall ppoossiittiioonnss ddiissttrriibbuuttiioonn.. 19

Fig 4-2 Anterior placenta. 20

Fig 4-3 Posterior placenta. 21

Fig 4-4 Fundal placenta. 22

Fig 4-5 Low lying placenta. 23

Fig 4-6 Fetal presentations ddiissttrriibbuuttiioonn. 27

Fig 4-7 Maternal blood groups ddiissttrriibbuuttiioonn. 31

List of Tables

Table

Title

Page

4-1 PPllaacceennttaall ppoossiittiioonnss

ddiissttrriibbuuttiioonn.. 18

4-2 Fetal presentations

ddiissttrriibbuuttiioonn. 25

4-3 PPllaacceennttaall ppoossiittiioonnss and fetal

presentations cross

tabulation(1). 25

4-4 PPllaacceennttaall ppoossiittiioonnss and fetal

presentations cross

tabulation(2). 26

4-5 Maternal blood groups

ddiissttrriibbuuttiioonn. 29

4-6 PPllaacceennttaall ppoossiittiioonnss and

Maternal blood groups cross

tabulation(1).. 29

4-7 PPllaacceennttaall ppoossiittiioonnss and

Maternal blood groups cross

tabulation(2).. 30

Contents

Title Page

Alaya. 1

Acknowledgement. II

Dedication. III

Abstract (Arabic). IV- V

Abstract (English). VI- VII

Lists of abbreviations. VIII

Lists of figures. IX

Lists of tables. X

The contents. X1 - X II

Chapter I: Introduction, Rationale & Objectives

1.1. Introduction 1-6

1.2. Justification. 6

1.3. Objectives: 7

1.3.1. General objective. 7

1.3.2. Specific objectives. 7

Chapter II: Literature Review

2.1. Literature Review . 8-10

Chapter III: Materials and Methods

3.1. Study Design. 11

3.2. Study Area and Duration. 11

3.3. Study Population. 11-12

3.4. Study variables. 12

3.5. Sampling.

3.5.1. Sample type.

13

3.5.2. Sample size and technique. 13-14

3.6. Data collection.

3.6.1. Data collection tools.

14-15

3.6.2. Data analysis. 15

3.6.3 Data management. 15

3.7. Ethical considerations. 15-16

Chapter IV: Results

4.1. Results. 17-31

Chapter V: Discussion

5.1. Discussion. 32-35

Chapter VI: Conclusion and Recommendations

6.1. Conclusion. 36

6.2. Recommendations. 37

Chapter VII: References

References. 38-41

Appendix:

Data collection sheet. 42

Chapter I Introduction, Rationale &

Objectives

1. INTRODUCTION

1.1. Introduction:

The placenta is the primary site of nutrient and gas exchange

between mother and fetus.(1)

The organ by means of which the

nutritive, respiratory, and excretory functions of the fetus are carried

on, and it connects the fetus to the uterine wall. (2)

The placenta composed of fetal and maternal portions. The fetal

portion of the placenta consists of the villi of the chorion frondosum,

this portion smooth, glistening and covers by the amnion which is

reflected on the cord. The umbilical cord is inserted near or at the

center of this portion and its radiating branches can be seen beneath the

amnion.(3)

A maternal portion is formed by the decidua basalis. This

portion is dull greyish red in color and is divided into 15-20

cotyledons. Each cotyledon is formed of the branches of one villus

stem covered by decidua basalis. (3)

At full term placenta has discoid shape, diameter of 15-25 cm, 3

cm thick and weight of about 500-600gm. At birth it is detaches from

uterine wall and about 30 minute after birth of the child is expelled

from uterine cavity. (4)

Implantation is a process by which the blastocyst attaches to

endometrium. About 6 days (day 20) after fertilization the

endometrium assists in implantation and contributes to the formation

of the placenta. At the time of implantation the endometrium is in the

secretory phase, during which uterine glands and arteries become

coiled. As a result three layers can be recogenized in endometrium,

superficial compact layer, intermediate spongy layer and deep basal

layer. Normally the human blastocyst implants in endometrium along

anterior or posterior wall of body of uterus, where it becomes

embedded between the openings of the glands. (5)

The placenta is usually attached near the fundus uteri, and more

frequently on the posterior than on the anterior wall of the uterus. The

site of the attachment is determined by the point where the blastocyst

becomes empadded. The placenta may be attached at any point on

uterine wall, but these variations have no complications to normal

labour unless its attachement so low down, that it overlies the internal

os uteri, when it may give rise to serious antepartum haemorrhage, the

condition known as placenta previa. (6)

There are many congenital anomalies which include abnormal

shape which includes placenta bilobata (the placenta consists of two

equal parts connected by placenta tissue), placenta bipartite (the

placentac onsists of two equal parts connected by membranes),

placenta succenturiata (the placenta consists of large lobe and smaller

one connecting together by membranes), placenta circumvallata

(whitish ring composed of decidua is seen around the placenta from its

fetal surface) and placenta fenestrata (gap is seen in placenta covered

by membranes giving appearance of window) .Abnormal weight which

indicates that the placenta increases in size and weight as in

congential syphilis hydrops foetalis and diabetes mellitus. Abnormal

position which includes that the placental abruption (is the premature

separation of the placenta from the myometrium usually in the late

second and third trimesters) and placenta previa (is presence of

placenta lying over or near the internal cervical os. There are three

types of placenta previa (complete, partial, and marginal). Abnormal

adhesion which includes placenta accrete (the chorionic villi penetrate

deeply into uterine wall to reach the myometrium due to deficient

deciduas basalis when the villi penetrate deeply into myometrium).

Placental lesion which includes placental infarcts mainly in

hypertensive state with pregnancy. Placental tumour which includes

chorioangioma (is rare benign tumour of placental blood vessels which

is associated with hydramnios). (7)

The functions of the placenta include metabolism (e.g., synthesis

of glycogen), transport of gases (e.g., oxygen, carbon dioxide, and

carbon monoxide) and nutrients (e.g., amino acids, free fatty acids,

carbohydrates, vitamins. (8)

Transmission of maternal antibodies (IgG).

(9) Endocrine functions since it secretes hormones like human chorionic

gonadotropin [HCG], human chorionic somatomammotropin or human

placental lactogen,human chorionic thyrotropin and human chorionic

corticotropin). (10)

1.2. Justification:

The positions of the placenta are quite variable, (11)

and they

affect the fetal presentation (14)

, and are affected by maternal blood

groups.

(17) No previous studies were found regarding the above mentioned

variables in Sudan.

The aim of this study is to establish data base about these factors

in Sudanese women and comparing them with other international

records.

1.3. Objectives:

1.3.1. General Objectives:

To determine the common position of the placenta in the second

trimester among Sudanese women in Khartoum state.

1.3.2. Specific Objectives:

To determine the common positions of the placenta in the second

trimester.

To determine the influence of placental location on the fetal

position in the uterus.

To assess association between different blood groups and

location of placenta.

Chapter II

Literature Review

2. Literature Review

Gray (11)

found that the placenta is usually attached near the

fundus, and more frequently on the posterior than on the anterior wall

of the uterus, and in about 0.5% of the cases it is attached to the lower

part of uterus overlying the internal os. This condition known as

placenta previa.

Chama et al (12)

studied that the low lying placenta occurs when

the placenta extends into the lower uterine segment and its edge lies

too close to the internal os of the cervix, without covering it. The

estimated prevalence may be as high as 10-30 % of all pregnancies,

while Gillieson et al. (13)

found the placenta normally lies along the

anterior or posterior wall of uterus and may extend to lateral wall.

Filipov et al (14)

studied the influence of placental location on the

foetal position in the uterus. Two groups of pregnant women were

examined the first with cephalic presentation (125 cases) and the

second with breech presentation (124 cases).The localization of the

placenta was determined by ultrasonography. The cornu-fundal

localization of the placenta was found in 4.8% in the pregnant women

with cephalic presentation and 62.6% in pregnant women with breach

presentation. Placenta praevia or low insertion of the placenta was

found in 3.2% of the cases with breech presentation and in none of the

cases with cephalic presentation.

Sekiguchi et al (15)

found that the breech presentation was the

most common in women who had low lying placenta, while Zaki et al

(16)

found cephalic presentation most common in women who had

upper placenta.

Ger (17)

studied the association between blood groups and

location of placenta. The study was done on 474 cases. He found

(54%) of women with an anterior placenta had O-positive blood group,

while 46% of women in the posterior placenta had A-positive blood

group.

Chapter III

Materials & Methods

3. Materials and Methods

3.1. Study Design:

It is descriptive cross-sectional study.

3.2. Study Area and Duration:

The study was conducted at the following centers:

Police hospital.

Friendship hospital Omdurman.

Maternity hospital Omdurman.

The study was conducted from April/ 2014 to July/ 2014 at the

centers mentioned above.

3.3. Study Population:

The study was done on 109 Sudanese women who attended

ultrasound examination for antenatal follow up in the second trimester

in Police Hospital, Friendship hospital Omdurman and Maternaty

hospital Omdurman.

3.3.1. Inclusion criteria:

Any Sudanese women in the second trimester of pregnancy

who undergo ultrasound examination for antenatal follow up in the

above hospitals.

3.3.2. Exclusion criteria:

Non Sudanese women.

Women who have uterine and fetal abnormalities.

Women in first and third trimesters.

Women who have negative blood groups.

3.4. Study variables:

Positions of placenta.

Presentations of fetus.

Maternal blood groups.

3.5. Sampling:

3.5.1. Sample type:

Sampling type is probability sampling – population proportion to

size then simple random sample suitable for this data and the selection

from population will be according to the size.

3.5.2. Sample size and technique:

Sample size:

n = N

1+Nd2

Where n is the sample size.

n= 920 = 901

1+ 920 (.05)2

N size of population

Desired margin of error tolerated (here was set at .o5)

109 U/S images were collected to fulfill the research

requirements after exclusion other images which were collected but

did not meet inclusion criteria of the research.

3.6. Data collection:

3.6.1. Data collection tools:

Trans-abdominalund images were collected by administors in order

to assess the position of placenta for each woman. Ultrasound machine

consists of a console containing a computer and electronics, a video

display screen and a transducer that is used to do the scanning. The

transducer is a small hand-held device that resembles a microphone,

attached to the scanner by a cord. The transducer sends out inaudible

high frequency sound waves into the body and then listens for the

returning echoes from the tissues in the body. Data collection sheets

were used to include the study variables (appendix). Clinical reports

were reviewed for each patient in order to include the clinician’s notes

in the results precisely.

3.6.2. Data Analysis:

Data entry, cleaning and analysis was performed with personal

computer using the statistical package for social science (SPSS),

version17, data analysis was done by my colleague who works in

research methodology.

3.6.3. Data Management:

Data were analyzed as mentioned above, and then descriptive

statistic presented in the, table, charts, graphs, and figures, as based on

the observed data.

3.7. Ethical Considerations:

Verbal consents from women and administors were delivered to

the radiology department at the above mentioned hospitals to precede

the collection of data.

Chapter IV

Results

4. Results

This study was done on 109 women, who did ultrasound

examination screening in the second trimester in Police hospital,

Friendship hospital Omdurman and Maternaty hospital Omdurman.

Most of the study group had anterior placenta (47.7%) fig (4.2), so

the commonest position of placenta in the second trimester was

anterior followed by posterior (29.4 %) fig (4.3), fundal (16.5%) fig

(4.4) and low lying placenta (6.4%) fig (4.5), as shown in table (4.1)

and fig (4.1)..

TTaabbllee ((44..11)):: ppllaacceennttaall ppoossiittiioonnss ddiissttrriibbuuttiioonn..

PPllaacceennttaall ppoossiittiioonnss FFrreeqquueennccyy PPeerrcceenntt

Upper anterior 52 47.7

Upper posterior 32 29.4

Low lying 7 6.4

Fundal 18 16.5

Total 109 100.0

FFiigg ((44..11)):: PPllaacceennttaall ppoossiittiioonnss ddiissttrriibbuuttiioonn

FFiigg ((44..22)):: AAnntteerriioorr ppllaacceennttaa

0

50

100

150

200

250

Anterior posterior low lying Fundal Total

52 32

7 18

109

47.7

29.4

6.4

16.5

100

Percent

Frequency

FFiigg ((44..33)):: PPoosstteerriioorr ppllaacceennttaa

FFiigg ((44..44)):: FFuunnddaall ppllaacceennttaa

FFiigg ((44..55)):: LLooww llyyiinngg ppllaacceennttaa

Cephalic presentation of fetus in the second trimester was found

in 99 (90.8%) women. Most of those women had upper anterior

placenta (45.9%), followed by upper posterior placenta (28, 4%) and

fundal placenta (16.5%), but cephalic presentation was not found in

women who had low lying placenta. Breech presentation of fetus in

the second trimester was found in 10 (9.2%) women, most of those

women had low lying placenta (6.4%), while only few had upper

anterior placenta (1.8%) and upper posterior placenta (0.9%) but it was

not found in women who had fundal placenta. No women had fetus

with transverse presentation, as shown in tables (4.2) , (4.4), fig (4.6).

Table (4.2): Fetal presentations distribution.

Fetal presentations Frequency Percent

Cephalic 99 90.8

Breech 10 9.2

Transverse 0 0

Table (4.3): Placental positions and fetal

presentations cross tabulation(1) .

Placental positions Cephalic

presentations Percent

Upper anterior 50 45.9

Upper posterior 31 28.4

Low lying 0 0

Fundal 18 16.5

Table (4.4): Placental positions and fetal

presentations cross tabulation(2) .

Placental

positions

Breech

presentations

Percent

Transverse

presentation

Upper anterior

2

1.8

0

Upper posterior

1

0.9

0

Low lying

7

6.4

0

Fundal

0

0

0

Fig (4.6): Fetal presentations distribution.

0

50

100

150

200

250

cephalic Breech Total

99

10

109

90.8

9.2

100

Percent

Frequency

Blood group O-positive was found in 54 (49.5%) women,

most of them had anterior placenta (33.9%), while blood group A-

positive in 32 (29.4%) women, most with posterior placenta

(19.3%), blood group B-positive in 13 (11.9%) women, with anterior

placenta (4.6%) or fundal placenta (4.6%) and blood group AB-

positive in 10 (9.2%) women, most of them had posterior placenta

(5.5%), as shown in tables (4.5) (4.7), fig (4.7).

Table (4.5): Maternal blood groups distribution.

Maternal blood groups Frequency Percent

O+ve 54 49.5

A+ve 32 29.4

B+ve 13 11.9

AB+ve 10 9.2

Table (4.6): Maternal blood groups and placental positions cross

tabulation (1)

Placental

positions O+ve percent A+ve percent

Upper anterior 37 33.9 6 5.5

Upper

posterior 2 1.8 21 19.3

Low lying 5 4.6 2 1.8

Fundal 10 9.2 3 2.8

Table (4.7): Maternal blood groups and placental positions

cross tabulation (2)

Placental

positions B+ve percent AB+ve percent

Upper anterior 5 4.6 4 3.7

Upper posterior 3 2.8 6 5.5

Low lying 0 0 0 0

Fundal 5 4.6 0 0

Fig (4.7): Maternal blood groups distribution.

0

50

100

150

200

250

O A B AB Total

54 32

13 10

109

49.5

29.4

11.9 9.2

100

Percent

Frequency

Chapter V

Discussion

5. Discussion

This study was done on 109 women, who underwent ultrasound

examination scanning in the second trimester in Police hospital,

Friendship hospital Omdurman and Maternaty hospital Omdurman.

Most of the study group had anterior placenta (47.7%). The commonest

position of placenta in the second trimester was upper anterior

followed by posterior (29.4 %), fundal (16.5%) and low lying placenta

(6.4%). This result did not match that study of Gray, (11)

who found the

placenta is usually attached near the fundus, and more frequently on

the posterior than on the anterior wall of the uterus, and about 0.5% of

the cases were attached to the lower part of uterus that overlies the

internal os .

This result also contradicts to the study of Chama et al (12)

who

found the low lying placenta occurs when the placenta extends into the

lower uterine segment and its edge lies close to the internal os of the

cervix, without covering it. The estimated prevalence was as high as

10-30 % of all pregnancies.

In the study done by Gillieson et al, (13)

the placenta was

normally lying along the anterior or posterior wall of and sometimes

extends to the lateral wall.

Cephalic presentation of fetus in the second trimester was found

in 99 (90.8%) women. Most of those women had upper anterior

placenta (45.9%), followed by upper posterior placenta (28.4%) and

fundal placenta (16.5%), but the cephalic presentation was not found in

women who had low lying placenta. Breech presentation of fetus in

the second trimester was found in 10 (9.2%) women, most of those

women had low lying placenta (6.4%) and it was less in women who

had upper anterior placenta (1.8%) and upper posterior placenta

(0.9%), but it was not found in women who had fundal placenta. No

women had fetus with transverse presentation. This result tallies to

that study of Filipov et al (14)

who found the cornu-fundal localization

of the placenta in (4.8%) of the pregnant women with cephalic

presentation and in (62.6%) of pregnant women with breech

presentation. Placenta praevia was found in ( 3.2%) of the cases with

breech presentation and in none of the cases with cephalic

presentation,

The present result was almost similar to the study of

Sekiguchi et al(15)

who found the breech presentation most common

in women who had low lying placenta, similar conclusion was reported

in the study of Zaki et al(16)

who found that the cephalic presentation

was most common in women who had upper placenta .

Blood group O-positive was found in 54 (49.5%) women,

with anterior placenta in (33.9%), blood group A- positive was found

in 32 (29.4%) women with posterior placenta in (19.3%), blood

group B-positive in 13 (11.9%) women, with anterior placenta in

(4.6%) or fundal placenta in (4.6%) and blood group AB- positive in

10 (9.2%) women, most of them had posterior placenta (5.5%). This

result is similar to that found by Ger (17)

who found (54%) of women

with anterior placenta had O-positive blood group, while ( 46%) of

women with a posterior placenta had A-positive blood group.

Chapter VI

Conclusion

&

Recommendations

6. Conclusion

6.1. Conclusion:

The commonest position of placenta in the second trimester

was upper anterior placenta.

The cephalic presentation of fetus in the second trimester was

found most common in women who had upper placenta and was

not found in women who had low lying placenta.

Breech presentation of fetus in the second trimester was most

commonly in women who had low lying placenta and less

common in women who had upper placenta.

Most of the women who had anterior placenta in the second

trimester had blood group O+ve and most of the women who

had posterior placenta in second trimester had group A+ve .

6.2. Recommendations:

Studies about placental positions, fetal presentation and maternal

blood groups are not enough in sudan, therefore more studies are

needed to confirm these results.

Most of the studies concentrated on placental positions, fetal

presentation and maternal blood groups and no studies were done on

other variables associated with the placenta like mode of the delivery,

maternal age, number of pregnancies and ethnic variations.

More researches are needed to discover the hidden areas of the

topics related to this study.

Chapter VII

References

References

(1) Moore Keith L et al. Placenta In: Agur Ann M R, Moore B A,

Sun B, Scogna K H editors. Developing human clinically oriented

embryology. 6th

ed. London: Lippincott Williams And Wilkins; 1998:

131.

(2) Gray H. Placenta. In: Lewise Warren H editor. Gray’s anatomy

of the human body. 20th

ed. Philadelphia: Lea and Febiger; 1918;130.

(3) Gray H. Placenta. In: Lewise Warren H editor. Gray’s anatomy of

the human body. 20th

ed. Philadelphia: Lea and Febiger; 1918;133-

134.

(4) Saddler T W. Fetus and Placenta. In: Lel J, Saddler S L, Tosmeyl

K, Chescheir N, Imseis H editors. Langmans medical embryology. 11th

ed. London: Lippincott Williams And Wilkins; 2011;97.

(5) Moore Keith L et al. Placenta. In: Agur Ann M R, Moore B A,

Sun B, Scogna K H editors. Developing human clinically oriented

embryology. 6th

ed. London: Lippincott Williams And Wilkins; 1998;

130.

(6) Molloy CE, McDowell W, Armour R, Crawford W, Bernstine

R. Ultrasonic diagnosis of placenta membranace in utero Ultrasound

Med 1983; 2:377-9.

(7) Gray H. Placenta In: Lewise Warren H editor. Gray’s anatomy of

the human body. 20th

ed. Philadelphia: Lea and Febiger; 1918;136 .

(8) Wright Caroline, Sibley, Colin P. Placental Transfer in Health

and Disease. The Placenta: From Development to Disease 2011;66.21-

40.

(9) Moore Keith L et al. Placenta In: Agur Ann M R, Moore B A,

Sun B, Scogna K H editors. Developing human clinically oriented

embryology. 6th ed. London: Lippincott Williams And Wilkins;

1998;138-140.

(10) Guyton E. Placenta In: William Schmitt E editor Textbook of

medical physiology .10th

ed. London; 2005; 11:1032–1033.

(11) Gray H. Placenta In: Lewise Warren H editor.Gray’s anatomy

of the human body. 20th

ed. Philadelphia: Lea and Febiger; 1918;135.

(12) Chama CM, Wanonyi IK, Usman JD. From low-lying

implantation to placenta praevia: A longitudinal ultrasonic assessment.

J Obstet Gynaecol. 2004; 24 (5): 516-8.

(13) Gillieson MS, Winer-muram HT, Muram D. Low-lying

placenta. Radiology. 1982; 144 (3): 577-80.

(14) Filipov E, Borisov I, Kolarov G. Placental location and its

influence on the position of the fetus in the uterus. PubMed 2000;

40(4):11-2.

(15) Atsuko Sekiguchi, Akihito Nakai, Ikuno Kawabata, Masako

Hayashi, Toshiyuki Takeshita. Low lying placenta and pregnancy

outcomes. J Obstet Gynaecol. 2013; 10(12). 1683–1688.

(16) Zaki ZM, Bahar AM, Ali Me et al .Placenta location and

pregnancy outcomes. Acta Obstet Gynecol Scand.1998; 77:391–4.

(17) J Turk Ger.Placental location and pregnancy outcome. PubMed

2013 Dec 1; 14(4):190-3.

Appendix

ثسى للا انشح انشحيى

The National Ribat University

Faculty of post graduate studies

Master program of clinical anatomy

Data Collection Sheet

Common Position of the placenta in the second trimester of

the pregnancy among Sudanese women in Khartoum state 2013.

Submitted by: Nahla Mohammed Elhadi Ali

Date: ………………………………………………………..

Pt No: ……………………………………………………….

Nationality: ………………………………………………………..

Study institute:

…………………………………………….…………………………………………….

1. Position of the placenta:

Upper anterior [ ] fundal [] upper posterior] [ Low-lying ] [

2. Position of fetus:

Cephalic [ ] Breech ] [ Transverse ] [

3-Maternal blood group:

A+ve [] B +ve [] AB+v ] [ O +ve ] [