Placenta Praevia Flashcards
Placenta Praevia
Placenta is attached in the lower portion of the uterus, lower than the presenting part of the fetus
When the placenta is over the internal cervical os
Low-lying placenta
Placenta is within 20mm of the internal cervical os
Risk of placenta praevia
Antepartum haemorrhage Emergency caesarean section Emergency hysterectomy Maternal anaemia and transfusions Preterm birth and low birth weight Stillbirth
Causes of antepartum haemorrhage
Placenta praevia
Placental abruption
Vasa praevia
Risk factors for placenta praevia
Previous caesarean sections
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities (e.g. fibroids)
Assisted reproduction (e.g. IVF)
Presentation of placenta praevia
Asymptomatic
Painless vaginal bleeding in pregnancy at around 36 weeks
When is placenta praevia identified
At 20 weeks anomaly scan
Management of placenta praevia
Corticosteroids (due to risk of preterm delivery)
Planned delivery
Monitoring of placenta praevia
Repeat transvaginal USS at:
32 weeks gestation
36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)
Why is delivery planned in placenta praevia
Risk of spontaneous labour and preterm birth
Risk of antepartum bleeding
Planned delivery in placenta praevia
Between 36 and 38 weeks gestation
Caesarean section
Management of haemorrhage
A-E
Inform senior
Emergency caesarean section
Blood transfusions - G+S and crossmatch
Intrauterine balloon tamponade
Uterine artery occlusion
Emergency hysterectomy
