Placenta Praevia

Question 1

Risk factors for placenta praevia

Answer 1

• Previous caesarean section
• Advanced maternal age
• IVF
• Smoking
• Multiparity
• Previous uterine surgery

Question 2

Placenta Praevia severity grade

Answer 2

• Low lying placenta- within 2-3.5cm of the internal os
• Marginal placenta praevia- <2cm from the internal os
• Complete placenta praevia- covering the internal os

Question 3

Placenta accreta spectrum

Answer 3

Accreta- invading the endometrium attached to the myometrium
Increta- invading the myometrium
Percreta- invading the myometrium and extension to the serosa and surrounding organs

Question 4

Pros & Cons of Neuraxial blockade (spinal/ CSE/ epidural) for Placenta Praevia

Answer 4

Pros
- Rapid onset of block
- Avoids airway compromise
- Reduced blood loss compared to GA
- Facilitates early maternal-foetal bonding
- Enable use of intrathecal long-acting opioids

Cons
- Block may be inadequate for length of surgery
- Not suitable if ongoing haemodynamic compromise

Question 4

Pros & Cons of General Anaesthesia for Placenta Praevia

Answer 4

Pros
- Appropriate for haemorrhage with haemodynamic instability

Cons
- Risk of airway complications
- Intra-op IV opioids required
- No early maternal-foetal bonding