Placenta Disorders Flashcards
Explain in general placenta accreta spectrum
Accreta: onto the myometrium
Increta: into myometrium
Percreta: through myometrium and to the uterine serosa or other organs
RF for placenta accreta
- Previous C-section (most common) or uterine surgery or deliveries → scar allows for improper embedding into the wall bc weak point
- Trauma
- Concurrent placenta previa
- ≥ 35Y
- Hx of placenta accreta
- Multifetal gestation
- Placenta previa w/ a hx of c-section
whats the patho for placenta accreta?
- Defect of the endometrial–myometrial interface
- failure of normal decidualization
- abnormally deep placental anchoring villi and trophoblast infiltration
how is placenta accreta diagnosis?
on u/s
otherwise asymptomatic and cannoy be prevented
what does placenta accreta result in during childbirth?
Result: incomplete separation of the placenta after childbirth
Cx: Excessive bleeding, preterm delivery, hysterectomy, surgical injury
what other ix should you do for placenta accreta?
CBC, electrolytes, VBG/ABG, coags, group and screen
how would you manage a preg pt with placenta accreta?
C-section and hysterectomy (always included in consent discussion)
Can consider uterine sparing procedures (expectant management w/ methotrexate or selective tissue removal) if possible and patient is strongly interested, but pt should be counselled on risks
define placenta previa
Placenta implants totally or partially in the lower segment of the uterus
Complete previa: internal os completely covered
Partial previa: portion of internal os covered
Marginal previa: edge of placenta extends to the edge of the cervical os
RF for placenta previa
- Previous C-section, abortion, uterine surgery
- Smoking
- Multifetal gestation
- Increasing parity (more preg)
- ♀ age
- Hx of placenta previa
patho for placenta previa
Prior uterine scars → environment rich in oxygen and collagen → good environment for trophoblast adherence → placenta previa
what s/s and physical exam results could you expect from placenta previa?
Painless vaginal bleeding in 2nd or 3rd trimester
what ix and physical exams would you do for placenta previa?
Transabdominal/vaginal U/S to assess location of placenta
Speculum exam: may visualize placenta if cervix is dilated
Do NOT complete a digital exam to avoid hemorrhage
CBC, INR/PTT, type and screen
how would you manage/tx a placenta previa pt?
most resolve by the time they are due
pt education: no sex and high pelvic load bearing activities
schedule an elective c-section at 36-37wks
give IV magnesium sulfate and corticosteroids to help with lung maturity and neuroprotection
define vasa previa
Unprotected fetal vessels passing over the cervical os
what are some etiologies/RF for vasa previa?
Velamentous umbilical cord insertion (not in the middle)
Bilobed placenta
Placenta previa
Multiple gestations
Hx of vasa previa
what s/s are associated vasa previa?
Asymptomatic
If rupture of cord - Painless vaginal bleeding, fetal distress
how do you evaluate vasa previa?
Transabdominal/vaginal U/S to assess location of placenta and umbilical insertion into placenta
how do you treat or manage vasa previa?
- Admission to hospital at 32W for close monitoring
- C-section at 35/36 weeks but if bleeding, URGENT because baby can bleed out within minutes
- IV mag sulfate and corticosteroids
- pt education: no sex and high pelvic load bearing activities
define placental abruption
placenta partly or completely separates from the inner wall of the uterus >20wks and before delivery
RF for placental abruption
Hx of abruption
Abdo trauma
Cocaine use
Chronic HTN
Preeclampsia
Smoking
Multiple gestation
what are s/s placental abruption?
painful vaginal bleeding + abdo/back pain
Contractions - threatened preterm labour
Shock s/s
Fetal s/s
- Destress
- bradycardia
ix for placental abruption
Clinically diagnosis + blood-stained amniotic fluid
Electronic fetal monitoring
CBC, INR/PTT, type and screen
tx for placental abruption
admit
transfuse
deliver baby
IV mag sulfate and steroids if baby premature
