9 - Obs - APH - Placenta Praevia Flashcards
Classification - type 1 = placenta in ? ? but not over os
type 2 = placenta over the ? of the os
type 3 = Placenta covers ? of os
type 4 = placenta covers ? of os
more common in ? pregnancies, women of high ? and ?, and if uterus ? (prev ??)
lower segment
edge
some
all
multiple
parity, age
scarred
C/s
Complx
Obstructs ? of head – except for some ? praevias - do ? ? , and may also cause ? lie.
? can be severe, may continue during and after ? as lower segment less able to ? and ? maternal BF.
engagement marginal C/s transverse haemorrhage delivery contract constrict
Complx
If placenta ? on prev c section ? it may be so ? as to prevent placenta ? (placenta ?) or even penetrate through ? wall into surrounding eg ?(placenta percreta).
Placenta accreta occurs in ?% women who have PP and prev c section scar. May provoke massive ? at deliv often leads to ?.
implants scar deep separation accreta uterine bladder 10% haemorrhage hysterectomy
Clinical features
Hx: ? painless bleeds, incr in ? and ? over several wks. May be severe. 1/3rd women have ? bleeding before ?
Ex: ? presx and ? lie common. Fetal head not ?
and ?. VE can cause massive ? so ? perform unless PP r/o.
intermittent freq intensity no delivery
breech transverse engaged high bleeding never
Ix
To make diagnosis: ???. Most PPs now diagnosed before any ?, if ? ? placenta on ?nd trim USS, repeated, vaginally if posterior, at ?wks to r/o PP. Placenta less than ?cm from internal ? is likely to be PP at ?. If placenta ? and under c sec ?, 3D power USS best to determine ? -> prepares for ? at delivery.
To assess fetal and maternal wellbeing: If bleeding, ???, ???, clotting, ? ?.
USS bleeding low lying 2nd 32 <2 os term anterior scar accreta haemorrhage
CTG
FBC
cross match
MGMT - Admission
Admit all women ?. If PP found on USS women may stay in til ? due to risk of massive ?. ? kept available, ? admin to Rh –ve women, ?? ? maintained, ? given if gestation <34wks. If ? admit at 37wks provided easy access to hospital.
bleeding delivery haemorrhage blood anti-D IV access steroids aSx
MGMT- delivery
Elective c section at ?wks by senior. ? and ?? haemorrhage common as ? ? doesn’t contract well after deliv. Earlier, ? deliv if ? is severe before this. V preterm preg can be prolonged w ? and blood ? if needed.
39 intraoperative PPh lower segment emergency bleeding observation transfusion
MGMT - delivery
Placenta ?/? should be anticipated, though placenta may also invade ? even if not PP over scar. Where anticipated, ? incision made away from ? – leave it in situ or remove ? ?. Partial separation/transection of ? by uterine incision may cause massive ?– trt inv ? of the inside of the ? after placental removal w ?, or frequently a ?.
accreta/percreta myometrium uterine placenta entire uterus placenta haemorrhage compression scar balloon hysterectomy
