Transvaginal sonography is now well established as the pre-
ferred method for the accurate localization of a low-lying
placenta. Sixty percent of women who undergo
transabdominal sonography (TAS) may have a reclassifica-
tion of placental position when they undergo TVS.
7–10
With
TAS, there is poor visualization of the posterior placenta,
11
the fetal head can interfere with the visualization of the
lower segment,
12
and obesity
13
and underfilling or overfill
-
ing of the bladder
14,15
also interfere with accuracy. For these
reasons, TAS is associated with a false positive rate for the
diagnosis of placenta previa of up to 25%.
16
Accuracy rates
for TVS are high (sensitivity 87.5%, specificity 98.8%, posi
-
tive predictive value 93.3%, negative predictive value
97.6%), establishing TVS as the gold standard for the diag
-
nosis of placenta previa.
17
The only randomized trial to date
comparing TVS and TAS confirmed that TVS is more ben
-
eficial.
18
TVS has also been shown to be safe in the presence
of placenta previa,
17,19
even when there is established vagi
-
nal bleeding. Magnetic resonance imaging (MRI) will also
accurately image the placenta and is superior to TAS.
20
It is
unlikely that it confers any benefit over TVS for placental
localization, but this has not been properly evaluated.
Furthermore, MRI is not readily available in most units