OBSTETRICS

Question 1

How do you describe placenta previa?

Answer 1

• Placenta is the organ that allows your blood to reach your baby so that the baby receives the oxygen and nutrients it needs
• Usually the placenta grows near the top of the womb however in your case, the placenta has grown near the bottom, so it is covering the entrance.
• Sometimes the placenta moves up as the pregnancy progresses, which can allow for natural vaginal birth, but in 1/200 women, the placenta remains at the bottom of the womb, at which point the C Section is the safest option.

Question 2

Risk factors for placenta previa

Answer 2

• Multiple pregnancies
• Previous caesarean section
• Fetal malpresentation or abnormal lie in the third trimester
• Previous history of placenta praevia
• Increasing age >35
• Smoking
• Multiparous
• Intrauterine fibroids

Question 3

How does placenta previa impact on pregnancy?

Answer 3

• You may not have any symptoms Atal
• However, since the placenta is covering the entrance to the womb, it might cause some bleeding
• we advise that you abstain from sex since this can increase the risk of bleeding
• you may notice a small amount of bleeding like a period, and if so it is important that you come into hospital for urgent assessment, as losing significant blood can impact both you and the baby
• if the bleeding settles, you can go back home
• if bleeding was significant, we would advise staying in hospital for the duration of your pregnancy.

Question 4

How do you classify placenta previa?

Answer 4

Minor- placenta is in the lower segment, near teh Os. There is still potential for vaginal delivery

Major- placenta is completely or partially covering the vaginal os.

Question 5

What are the delivery options with placenta previa?

Answer 5

• As your womb grows more, the placenta might move away from the opening of the womb, if this is teh case then it is less likely to cause problems and you may be able have a vaginal delivery
• however, if the placenta continues to stay low down then it will block the passage for your baby to be delivered vaginally. We would then recommend a planned c-section at 39 weeks.

if a bleed occurs before the planed 39 weeks, then we may bring the C Section forward.

Question 6

How do you investigate someone with painless vaginal bleeding in pregnancy?

Answer 6

-Abdominal and Speculum
-Do not do a vaginal examination!
- Fetal cardiotocography (CTG) to check fetal well- being
- transvaginal ultrasound alongside Abdominal USS
- Bloods- FBC, U&E, CRP, LFT, Clotting profile, Group and save, kleinhauer test if rhesus D neg

Question 7

Differentials for placenta previa?

Answer 7

-vasa previa
- cervical ectropion

Question 8

How do you manage someone with identified placenta previa (no active bleeding)?

Answer 8

-antenatal corticosteroids
- iron supplementation if anaemic
- Anti-D immunoglobulin if Rhesus D neg
- serial USS every 2 weeks
- Plan for C section at 37-38 weeks

Question 9

Indications for delivery before 37 weeks of gestation in a case of placenta praevia?

Answer 9

o Onset of labour (not able to be suppressed).
o Fetal distress.
o Severe growth restriction.
o Intra-uterine death.
o Severe bleed (threatening maternal health).

Question 10

What is a breech presentation?

Answer 10

• We have done an USS to see how your baby is positioned in the womb and have found that he is in the ‘breech presentation’
• 3-4% of pregnancies are in breech presentation
• In your case, this means your baby’s bottom is at the exit of the other’s womb, (where the head should be),
• this means if you were to have a vaginal delivery, if the baby came out bottom first there are higher chances of complications

Question 11

what causes breech presentation?

Answer 11

No cause is identified in most cases, it may be associated with certain conditions preventing enlargement of the head such as:
- twins
-oligohydramnios
- Polyhydramnios
- uterine fibroids
- placenta praevia
- Pelvic tumour
- Pelvic deformities

Question 12

How do we manage breech?

Answer 12

A procedure called external cephalic version (ECV) at 36 weeks (37 if second pregnancy)
- This involves a clinician attempting to rotate the baby manually by putting their hands on your tummy
- usually you will be given some medication to relax yourself
- This procedure decreases the need for C Section. The immediate success rate is about 50%, but in 10% of these, the baby will revert back to the breech position.

Question 13

What are contraindications for breech?

Answer 13

Previous C section
Foetal compromise
Twins
Ruptured membranes
Antepartum hemorrhage

Question 14

Complications of placenta previa?

Answer 14

anaemia
Rh-D sensitisation
preterm birth
IUGR