Placenta praevia

Question 1

What is placenta praevia

Answer 1

Low lying placenta - placenta egde <2cm from Os on TVUSS
placenta praevia - placenta OVER the OSS (only diagnosed after 32w)
90% of low lying placenta go to normal area

RF -
Multiple preg, increased maternal age, Previous uterine surgery (ceserian), Previous Placenta praveia), smoke, IVF

Question 2

Sx and ix placenta praevia

Answer 2

Sx- painless PV bleeding in 2nd or 3rd trimester
potential sign of shock if big bleed

Ix -
1st line TVUSS
Bllods - FBC, blot, G&S. UE, LFT
Rhesus test - if mother Rh -ve -check levels of placental blood in mum blood (Kleinhauer test)

CTG
-THEORETICALLY no bimanual, unclear if true)

Question 3

Mx of placenta praevia and low lying placenta

Answer 3

minimal PV bleed that is vaginal + exclude vaginal cancer - when settles, admit for obs

always avoid SEX

Low lying placenta before 20w (and no PV bleed) –
90% go back to normal before delivery
Rescan at 32w- if present grade I/II (not in from of Os)- rescan at 36w, if still low-> cesarian)
If grade III/IV- admit at 34w and cesarian at 37
vagnial only ok if grade 1 after USS at 36

antenatal steroids from 34-36w- can be earlier if preterm

Placenta pravie/heavy bleed/shock
ABC- IV acess and fluids
Bloods - FBC, GS, Rhesus, Kleinhauer (if neg) 
AntiD if Rh- and kleihauer
Steroids - can be from 4w to 34

Scans - CTG if 27W, umbilical artery dopppler every 2w
Growth scans
Induction of labour if early foetal compromise
ADMIT until bleeding stop +48h to observe

Question 4

Complications of placenta praevia

Answer 4

Maternal mortality 1in 300 -n heamorage, ante or post partum, DIC
Foetal - IUGR, death