Placenta Praevia

Question 1

Antepartum haemorrhage definition

Answer 1

Vaginal bleeding after 24th week of pregnancy

Question 2

Placenta praevia

Answer 2

Placenta inserted wholly or partially into the lower segment of the uterus
Graded I - IV

Question 3

Risk factors

Answer 3

Previous history/family history
Advanced maternal age
Increasing parity
Smoking
Cocaine use
Previous C-section
Previous abortion

Question 4

Clinical presentation

Answer 4

Incidental on routine ultrasound
Painless bleeding, usually after 28 weeks, usually sudden and perfuse
Spontaneous labour follows within few days in 25%
May be impossible to push high presenting part into pelvis
Abnormal lie

Question 5

Management

Answer 5

Acute bleeding: admit to hospital
Minor (I and II) may deliver vaginally
Major (III and IV) require C-section, if possible this should be delayed to 38 weeks
Care bundle with six elements:
1) Consultant obstetrician directly supervising delivery
2) Consultant anaesthetist directly supervising anaesthetic at delivery
3) Blood and blood products available
4) MDT involvement in pre-operative planning
5) Discussion and consent including possible interventions
6) Locally available level 2 critical care bed
Major placenta praevia with bleeds admitted from 34 weeks
Steroids if pre-term delivery anticipated

Question 6

Complications

Answer 6

Maternal: bleeding => shock; infection; embolism; placenta accreta/percreta
Foetal: haemorrhage, prematurity; intrauterine asphyxia; birth injury