Placenta Praevia Flashcards
What is placenta praevia?
Placenta wholly or partly inserting into lower segment.
What are the RFs of placenta praevia?
Multiple pregnancy, increased maternal age, previous uterine surgery, previous PPREV, smoking.
What is the epidemiology of placenta praevia?
0.5% of pregnancies
What would you find in the history of placenta praevia?
Detected on routine USS. Acutely presents with painless bleed PV in T2/T3.
What would you find in the examination of placenta praevia?
· General: shock, tachy/hypotension.
· Abdomen: soft,nontender, malpresentation
· Vaginal CONTRAINDICATED
· Speculum: gentrle, to assess bleeding
What is the pathology of placenta praevia?
Unknown. Abnormal implantation thought to occur where blood supply is changed (i.e. previous scar). Bleeding secondary to shearing force.
· Minor PP: placenta close to but not covering internal cervical os
· Major PP: overlying internal cervical os.
What investigations would you do for placenta praevia?
Bloods: FBC, UE, clotting, Xmatch
Extra scan for PPREV (32wk)
USS: to confirm PPREV
CTG: fetal wellbeing
MRI: may be used to determine placenta accreta (adherent to uterine wall) or placenta increat/percreta (invading through the uterine wall).
What is the management of placenta praevia?
Repeat scans past anomaly scan
Any bleed - stay from 34 wks for safety for labour
Vaginal delivery: only if lower placental edge is >2cm from internal os and fetal head is below placenta.
C section. If no bleeding at presentation aim to wait until 38wk.
· Mild self limiting bleed with no compromise: admit to monitor, steroids if preterm, anti-D if Rh-.
· Severe bleed with compromise: manage as for severe placental abruption
No penetrative sex!
What is the complications/ prognosis of placenta praevia?
Maternal: haemorrhage, APH, PPH, DIC, VTE, hysterectomy needed.
Fetal: IUGR, death, hypoxia. Maternal mortality 1/300
