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Nama : IRMA SERIANA

No. BP : 1121228032

PubMed Health
PubMed Health. A service of the National Library of Medicine, National Institutes of Health.
A.D.A.M. Medical Encyclopedia. Atlanta (GA): A.D.A.M.; 2011.
A.D.A.M. Medical Encyclopedia.

Placenta previa
Last reviewed: September 12, 2009.
Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part
of the womb (uterus) and covers all or part of the opening to the cervix.
The placenta is the organ that nourishes the developing baby in the womb.
Causes, incidence, and risk factors
During pregnancy, the placenta moves as the uterus stretches and grows. In early pregnancy,
a low-lying placenta is very common. But as the pregnancy progresses, the growing uterus
should "pull" the placenta toward the top of the womb. By the third trimester, the placenta
should be near the top of the uterus, leaving the opening of the cervix clear for the delivery.
Sometimes, though, the placenta remains in the lower portion of the uterus, partly or
completely covering this opening. This is called a previa.
There are different forms of placenta previa:
Marginal: The placenta is against the cervix but does not cover the opening.
Partial: The placenta covers part of the cervical opening.
Complete: The placenta completely covers the cervical opening.
Placenta previa occurs in 1 out of 200 pregnancies. It is more common in women who have:
Abnormally developed uterus
Many previous pregnancies
Multiple pregnancy (twins, triplets, etc.)
Scarring of the uterine wall caused by previous pregnancies, cesareans, uterine
surgery, or abortions
Women who smoke or have their children at an older age may also have an increased risk.
Possible causes of placenta previa include:
Abnormal formation of the placenta
Abnormal uterus
Large placenta
Scarred lining of the uterus (endometrium)
Symptoms
The main symptom of placenta previa is sudden, painless vaginal bleeding that often occurs
near the end of the second trimester or beginning of the third trimester. In some cases, there is
severe bleeding, or hemorrhage. The bleeding may stop on its own but can start again days or
weeks later.
There may be uterine cramping with the bleeding. Labor sometimes starts within several days
after heavy vaginal bleeding. However, in some cases, bleeding may not occur until after
labor starts.
See: Vaginal bleeding in pregnancy
Signs and tests
Your health care provider can diagnose placenta previa with an ultrasound exam. Most cases
of placenta previa are identified by routine ultrasound during pregnancy.
Treatment
Treatment depends on various factors:
How much bleeding you had
Whether the baby is developed enough to survive outside the uterus
How much of the placenta is covering the cervix
The position of the baby
The number of previous births you have had
Whether you are in labor
Many times the placenta moves away from the cervical opening before delivery.
If the placenta is near the cervix or is covering a portion of it, you may need to reduce
activities and stay on bed rest. Your doctor will order pelvic rest, which means no
intercourse, no tampons, and no douching. Nothing should be placed in the vagina.
If there is bleeding, however, you will most likely be admitted to a hospital for careful
monitoring.
If you have lost a lot of blood, blood transfusions may be given. You may receive medicines
to prevent premature labor and help the pregnancy continue to at least 36 weeks. Beyond 36
weeks, delivery of the baby may be the best treatment.
If your blood type is Rh-negative, you will be given anti-D immunoglobulin injections.
Your health care providers will carefully weigh your risk of ongoing bleeding against the risk
of an early delivery for your baby.
Women with placenta previa most likely need to deliver the baby by cesarean section. This
helps prevent death to the mother and baby. An emergency c-section may be done if the
placenta actually covers the cervix and the bleeding is heavy or very life threatening.
Expectations (prognosis)
Placenta previa is most often diagnosed before bleeding occurs. Careful monitoring of the
mother and unborn baby can prevent many of the significant dangers.
The biggest risk is that severe bleeding will require your baby to be delivered early, before
major organs, such as the lungs, have developed.
Most complications can be avoided by hospitalizing a mother who is having symptoms, and
delivering by C-section.
Complications
Risks to the mother include:
Death
Major bleeding (hemorrhage)
Shock
There is also an increased risk for infection, blood clots, and necessary blood transfusions.
Prematurity (infant is less than 36 weeks gestation) causes most infant deaths in cases of
placenta previa. The baby may lose blood if the placenta separates from the wall of the uterus
during labor. The baby also can lose blood when the uterus is opened during a C-section
delivery.
Calling your health care provider
Call your health care provider if you have bleeding from the vagina at any point in your
pregnancy. Placenta previa can be dangerous to both you and your baby.
Prevention
This condition is not preventable.
References
1. Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG,
Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed.
Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 18.
2. Houry DE, Abbott JT. Acute complications of pregnancy. In: Marx J, ed. Rosens
Emergency Medicine: Concepts and Clinical Practice. 6th ed. St Philadelphia, Pa:
Mosby Elsevier; 2006:chap 177.
3. Cunnigham FG, Leveno KL, Bloom SL, et al . Obstetrical hemorrhage. In:
Cunnigham FG, Leveno KL, Bloom SL, et al, eds. Williams Obstetrics. 22nd ed. New
York, NY; McGraw-Hill; 2005:chap 35.
Review Date: 9/12/2009.
Reviewed by: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer,
Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies,
University of Washington School of Medicine; and Susan Storck, MD, FACOG,
Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative
of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of
Obstetrics and Gynecology, University of Washington School of Medicine. Also
reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Piracetam for fetal distress in labour
First published: April 27, 1998; This version published: 2010. Review content assessed as up-
to-date: June 23, 2009.
Piracetam is thought to support the metabolism of brain cells when they have an insufficient
oxygen supply (hypoxia). It may, therefore, prevent any adverse effects for an infant with
persistent fetal distress during labour.
This review set out to assess the effects of piracetam for suspected fetal distress in labour on
method of delivery and newborn ill effects (morbidity). Only one controlled trial was
identified. The trial randomised 96 women to receive either piracetam or a
placebo. Piracetam treatment was associated with a trend toward reduced need for a
caesarean section as the method of delivery and an improved outcome for the newborn as
determined by respiratory problems and signs of hypoxia. The trial did not provide
information about any side effects experienced by the mother. This evidence is insufficient
for meaningful conclusions.
Editorial Group: Cochrane Pregnancy and Childbirth Group.
Publication status: Edited (no change to conclusions).
Citation: Hofmeyr GJ, Kulier R. Piracetam for fetal distress in labour. Cochrane
Database of Systematic Reviews 1998, Issue 2. Art. No.: CD001064. DOI:
10.1002/14651858.CD001064. [PubMed: 10796235]
Maternal oxygen administration for fetal
distress
First published: October 20, 2003; This version published: 2008. Review content assessed as
up-to-date: June 29, 2007.
Too little evidence to show whether oxygen administration to the woman during labour is
beneficial to the baby.
Some babies show signs of distress, such as unusual heart rates or the passing of a bowel
motion (meconium) during their mother's labour. This may be caused by a lack of oxygen
passing from the woman to the baby through the placenta. Sometimes, women may be
encouraged to breathe extra oxygen through a facemask (oxygen administration) to increase
the oxygen available to the unborn baby. A review of two trials found too little evidence to
show whether oxygen administration to the woman during the second stage of labour is
beneficial to the baby. No trials of oxygen administration when the baby is showing signs of
distress were found. Further research is needed.
Tocolysis for preventing fetal distress in
second stage of labour
First published: April 22, 1996; This version published: 2011. Review content assessed as up-
to-date: April 19, 2011.
Betamimetic tocolytics are drugs that reduce contractions and delay labour, which can
improve placental blood flow and fetal oxygenation. They may be suggested to a woman
during labour if the baby is showing signs of stress, such as an unusual heartbeat. Tocolysis
may also be used to prevent fetal distress (prophylactically) during the second stage of
labour, the time from when the cervix is fully dilated by the babys head to actual childbirth.
The review authors searched the medical literature for randomised controlled trials
comparing prophylactic intravenous betamimetic therapy with inactive or no treatment for
women with uncomplicated pregnancies and whose babies were not showing signs of stress
during the second stage of labour. They identified two trials involving 164 women, both
conducted in the 1970s. One trial reported on clinical outcomes and found no beneficial
differences in clinical neonatal outcome or Apgar scores at two minutes with tocolysis. The
mean umbilical arterial pH values were slightly higher in the treatment groups of the two
trials and intravenous betamimetics may prevent the deterioration of fetal arterial pH levels
during the second stage of labour, possibly related to use of the supine position in these trials.
Women receiving betamimetic drugs were more likely to have forceps delivery, which is the
use of surgical tongs to assist the baby through the birth canal. Both trial protocols required
forceps to be used if the second stage of labour, or time from initiation of the betamimetic
infusion, exceeded 30 minutes. There were no clear differences in postpartum haemorrhage.
The authors found inadequate evidence of benefit to recommend the prophylactic use of
tocolytics in the second stage of labour.
Editorial Group: Cochrane Pregnancy and Childbirth Group.

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