Sei sulla pagina 1di 10

PLACENTA

PRAEVIA

DEFINITION
Placenta praevia exists when the placenta
is inserted wholly or partially into the lower
segment of the uterus.
Placental migration occurs during the
second and third trimesters, owing to the
development of lower uterine segment (2834 weeks)
Therefore, before this, we cannot diagnose
this condition as placenta praevia. It is
termed as low lying placenta.

CLASSIFICATION

PATHOPHYSIOLOGY
Placental implantation is initiated by the embryo
adhering in the lower uterus. With placental attachment
and growth, the developing placenta may cover the
cervical os.
However, it is thought that a defective decidual
vascularization occurs over the cervix, possibly
secondary to inflammatory or atrophic changes
A leading cause of third-trimester hemorrhage, placenta
previa presents classically as painless bleeding. Bleeding
is thought to occur in association with the development
of the lower uterine segment in the third trimester.
Placental attachment is disrupted as this area gradually
thins in preparation for the onset of labor and this leads
to bleeding at the implantation site, because the uterus
is unable to contract adequately and stop the flow of
blood from the open vessels.

RISK FACTORS
Multiple Pregnancy
Previous Caesarean section/ D&C/
Evacuation of retained products of
conception
Uterine structural abnormalities
Assisted conception
Advanced maternal age
Placental acreta(adhere),
increta(invade), percreta(penetrate
through myometrium)

CLINICAL FEATURES
Per vaginal bleeding, painless
Soft, non-tender abdomen
High presenting
parts/malpresentation
Compromised maternal circulation
Fetal compromised in severe cases.

INVESTIGATIONS
I. Transabdominal Sonography
.
The simplest, most precise, and safest
method of placental localization.
.
To confirm diagnosis, scan must be \
repeated after formation of lower
segment of uterus (34 weeks)
2. Color Doppler Ultrasonography performed
if
patient have high risk of placenta accerta.

MANAGEMENT
All patients with minor placenta praevia can be
managed conservatively and treat as
outpatients.
Patient with major placenta praevia, if there is
previous bleeding:
I. Should be admitted and managed as inpatients
from 34 weeks of gestation.
II. Prolonged inpatient care can be associated with
an increased risk of thromboembolism, thus
gentle mobility should be encouraged together
with the use of prophylactic thromboembolics.
III. Prophylactic anticoagulation should be reserved
for those at high risk of thromboembolism

Educate patients on:


I. No abdomen massage
II. No coital
III. Bed rest
IV. Immediate admit if there is contraction
V. Get hysterectomy consent if placenta
praevia overlies previous scar.
. Immediate Caesarean section indicated if:
I. Gestational age is > 36 weeks of
gestation
II. Profuse bleeding or Fetal distress

If there is no risk on maternal, can go


for conservative management:
I. Minor: Spontaneous Vaginal
Delivery
II. Major: Elective Caesarean Section to
minimize neonatal morbidity.