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Gaby’s Green Top Guidelines > 2018 27a Placenta Praevia & Placenta Accreta > Flashcards

2018 27a Placenta Praevia & Placenta Accreta Flashcards

1
Q

What are the risk factors for placenta praevia?

A
  1. Previous CS, increasing with number
  2. Assisted reproductive technology
  3. Maternal smoking
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2
Q

How do we screen for placenta praevia?

A

Mid pregnancy routine anomaly scan

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3
Q

** What placenta praevia terminology is used? **

A
  1. Placenta praevia when placenta directly over internal os
  2. Low-lying placenta when 16+/40 & placental edge <20mm from os
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4
Q

** What is the placenta praevia follow-up? **

A
  1. 32/40 TVUS
    (NB short cervical length <34/40 ⬆️ risk PTB & MOH)
  2. 36/40 TVUS if persistent & asymptomatic, to inform MoD
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5
Q

** When are antenatal steroids offered in placenta praevia? **

A
  1. Single course 34+0 to 35+6
  2. Prior to 34/40 if high risk PTB
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6
Q

** When are tocolytics used & not used in placenta praevia?**

A
  1. Used for 48 hours to enable steroids & transfer
  2. Not used to prolong gestation if maternal or fetal concerns
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7
Q

** At what gestations should planned delivery occur in placenta praevia? **

A
  1. 36+0 to 37+0 if uncomplicated
  2. 34+0 to 36+6 if hx PVB or other risk factors for PTB
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8
Q

** How should delivery be optimised in placenta praevia? **

A
  1. Prepare for blood transfusion +/- hysterectomy
  2. Involve haematologist & blood bank if atypical antibodies
  3. Prevent & treat anaemia
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9
Q

** What surgical approach should be used in placenta praevia? **

A
  1. Consider vertical incisions with transverse lie, particularly <28/40
  2. Consider pre/intraop US for placental location
  3. If placenta transected, immediately clamp cord after fetal delivery
  4. Early use of intrauterine tamponade &/or surgical haemostasis &/or IR
  5. Early recourse to hysterectomy
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10
Q

** What are the risk factors for placenta accreta spectrum? **

A
  1. Hx of accreta
  2. Previous Caesarean, increasing with number
  3. Previous uterine surgery including repeat curettage
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11
Q

** How is PAS diagnosed & referred? **

A
  1. Routine anomaly scan
  2. Specific screening if LLP with hx CS
  3. Refer to specialist unit if suspected
  4. MRI for depth of invasion & lateral extension
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12
Q

** When should delivery be planned for PAS? **

A

35+0 to 36+6 if no RFs for PTB

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13
Q

** What additional things should be consented for in CS for PAS? **

A
  1. MOH
  2. ⬆️ risk of urinary tract damage
  3. Blood transfusion
  4. Hysterectomy
  5. Cell salvage
  6. IR if available
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14
Q

** What surgical approach should be used for PAS? **

A
  1. CS hysterectomy with placenta left in situ
  2. Consider uterus-preserving surgery eg partial myometrial resection if limited extent, accessible & visualised
  3. Stents if bladder invaded
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15
Q

What is the incidence of placenta praevia?

A

1:200 pregnancies

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16
Q

What is the prevalence of placenta accreta?

A

1:300 to 1:2000!!

17
Q

How many cases of LLP resolve by term?

A

90%

18
Q

How often should G&D be sent in placenta praevia?

A

Weekly

19
Q

What are the greyscale US signs of PAS?

A
  1. Loss of the “clear zone”
  2. Bladder wall interruption
  3. Myometrial thinning
  4. Placental bulge
  5. Focal exophytic mass
20
Q

What are the greyscale US signs of PAS?

A
  1. Loss of the “clear zone”
  2. Bladder wall interruption
  3. Myometrial thinning
  4. Placental bulge
  5. Focal exophytic mass
21
Q

What are the Doppler US signs of PAS?

A
  1. Uterovesical hypervascularity
  2. Subplacental hypervascularity
  3. Bridging vessels
  4. Placental lacunae feeder vessels
22
Q

What are the 6 elements of good care for PAS?

A
  1. Consultant obstetrician
  2. Consultant anaesthetist
  3. Blood & blood products available
  4. MDT involvement in pre-op planning
  5. Discussion & consent of interventions
  6. Local availability critical care level 2

Gaby’s Green Top Guidelines (16 decks)

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