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Obs (Owen) > Placenta > Flashcards

Placenta Flashcards

1
Q

Where should placenta lie

A

High away from the cervix

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2
Q

What are the different types of placenta praevia

A

Marginal- where only a bit overlying
Partial- where large proportion covered
Complete- where whole of cervix covered

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3
Q

Where should placenta sit

A

On a basal layer above endometrium

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4
Q

What is placenta accreta

A

Implanted through decidua onto superficial myometrium

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5
Q

What is placenta increta

A

Invaded into myometrium

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6
Q

What is placenta percreta

A

Where has invaded through the uterus into the bladder most commonly

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7
Q

Risk factors for placenta praevia

A

Multiple pregnancies
Previous C-section
Abnormal uterus
Assisted conception

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8
Q

How to image placenta praevia

A

TVUSS

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9
Q

How to grade placenta praevia

A

I- encroaches on lower segment of uterus
II- reaches internal OS but does not cover it
III- covers internal OS but not completely
IV- completely covers internal OS

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10
Q

Causes of bleeding in different trimesters

A

At any time could be UTI etc

1st
- ectopic, miscarriage, hydatidiform mole
2nd
- miscarriage, molar, placental abruption
3rd
- placental abruption, praevia, vasa praevia, bloody show

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11
Q

What is vasa praevia

A

Post ROM can get bleeding

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12
Q

What is bloody show

A

Pre labour can get bleeding indicating impending labour

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13
Q

Management of placental abruption

A

Determine if over 36 weeks or not

Under 36 weeks
- fetal distress then C section ASAP
- no fetal distress then steroids and admit for close observation

Over 36 weeks
- fetal distress then C section ASAP
- no fetal distress then deliver vaginally

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14
Q

Management of placental abruption if baby dead

A

Deliver vaginally

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15
Q

Rfx for placental abruption

A

Cocaine use
HTN
Smoking
Trauma to abdomen (car crash, fall, domestic abuse)
Increasing maternal age
Multiparous

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16
Q

Placental abruption on examination

A

Tender tense uterus
Shock out of keeping with blood loss
Normal lie
Baby in distress

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17
Q

Complications of placental abruption

A

Maternal
- DIC
- Renal failure
- PPH
- Sheehan’s

Baby
- IUGR
- fetal hypoxia

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18
Q

What determines if bleeding in placental abruption

A

If the separation is near margin then will bleed however if it is central it will be concealed

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19
Q

What would cause a delayed stage 3 of labour

A

Placenta accreta

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20
Q

Definitive management for placenta accreta

A

Hysterectomy

21
Q

Most common cause antepartum haemorrhage

A

Placental rupture

22
Q

What classes as low lying placenta

A

Within 2cm of internal OS

23
Q

What classes as placenta praevia

A

Covering the internal OS

24
Q

If have low-lying placenta at anomaly scan what do

A

Follow-up USS at 32 weeks ideally with TVUSS

25
Q

If low-lying placenta still seen at 32 weeks on TVUSS what do

A

Re-scan at 36 weeks

26
Q

From what point in pregnancy can placenta be described as low lying or praevia

A

16 weeks

27
Q

Management of asymptomatic placenta praevia at 32 weeks

A

Treat as outpatient
- safety net about bleeding and sex
Give steroids at 34-36 weeks
Re-scan at 36 and deliver within a week if still placenta praevia

28
Q

What noted at 32 week USS may change management

A

Short cervical length as indicates increased risk of PPH and preterm

29
Q

Management of someone with recurrent bleeding from low-lying placenta/placenta praevia

A

Tailor between hospitilisation and outpatient based on distance to hospital from home, transport, bleeding episodes and haem results
Can admit steroids prior to 34 weeks
Deliver 34-36 weeks

30
Q

If have any pain, bleeding or contractions when treated as outpatient with placenta praevia what do

A

Come to hospital

31
Q

If admitted to hospital with bleeding from placenta praevia what do

A

A-E
Treat blood loss
VTE risk assessment balanced against risk of bleeding from placenta

32
Q

When are antenatal steroids given in placenta praevia

A

Anyone between 34 and 35+6 but can before if high risk of preterm like short cervical length

33
Q

When and how should deliver if placenta praevia

A

If asymptomatic 36-37 weeks
If bleeding and risks of preterm then 34-36+6
Ideally C-section but can consider vaginal if low lying and asymptomatic

34
Q

What anaesthetic for placenta praevia

A

Regional but may have to convert to general

35
Q

What do if placenta praevia goes into preterm labour

A

Can use tocolysis and antenatal before c-section

36
Q

Rfx for placenta accreta

A

Previous c-sections
Uterine surgery
Anterior low-lying or placenta

37
Q

What should do if previous c-sections and seen to have anterior low lying placenta on mid term USS

A

Screened for placenta accreta

38
Q

What is best way to diagnose placenta accreta

A

USS and MRI by highly skilled radiographer equally as specific
MRI may help detail depth of invasion

39
Q

Risks in surgery of placenta accreta

A

Damage to urinary tract
Haemorrhage
Transfusion
Hysterectomy

40
Q

Management of placenta accreta

A

MDT approach
Planned c-section at 35-36+6
Trained memebers of team
Blood products present

41
Q

What is surgical approach for palcenta accreta

A

Attempt myometrial resection
May have to resort to hysterectomy

42
Q

Surgical approach for placenta percreta

A

C-section hysterectomy

43
Q

Difference between revelaed and concealed placental abruption

A

Revealed -Presents with vaginal bleeding
Concealed- Presents with no bleeding but can be seen on USS as clot between placenta and endometrium

44
Q

What is perimetrium

A

Outer layer of uterus

45
Q

Post abruption management

A

Re-classified as high risk so consultant led
Serial scans for FGR

46
Q

Management of low lying placenta at 36 weeks

A

Personalised decision on birth

47
Q

What at anomaly scan would encourage to look for placenta accreta

A

Anterior and previous C-section
History of placenta accreta

48
Q

If find placenta accreta on USS what do

A

Refer to specialist team

Obs (Owen) (9 decks)

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