Placenta Praevia & Accreta Spectrum Flashcards
What is placenta praevia?
Condition where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the fetus.
Defined by RCOG guidelines 2018.
What is a low-lying placenta?
Placenta is within 20mm of the internal cervical os.
This is a classification under placenta praevia.
What is placenta praevia in relation to the internal os?
Placenta is over the internal os.
This is a key definition in understanding placenta praevia.
What are the notable causes of antepartum haemorrhage?
- Placenta praevia
- Placental abruption
- Vasa praevia
Antepartum haemorrhage can lead to serious complications.
What are some risks associated with placenta praevia?
- Antepartum haemorrhage
- Emergency caesarean section
- Emergency hysterectomy
- Maternal anaemia and transfusions
- Preterm birth and low birth weight
- Stillbirth
These risks highlight the severity of placenta praevia.
What are risk factors for placenta praevia?
- Previous caesarean section
- Previous placenta praevia
- Older maternal age
- Maternal smoking
- Structural uterine abnormalities (e.g. fibroids)
- Assisted reproduction (e.g. IVF)
Understanding risk factors helps in the management and prevention of complications.
What clinical features are associated with placenta praevia?
- Painless vaginal bleeding in pregnancy (antepartum haemorrhage)
- Many women are asymptomatic
- Diagnosed via 20 week anomaly scan
Symptoms can vary widely among patients.
What is the management for early diagnosis of low-lying placenta or placenta praevia?
Additional transvaginal USS at 32 and 36 weeks gestation.
Early diagnosis is crucial for effective management.
What role do corticosteroids play in managing placenta praevia?
Given between 34 and 35+6 weeks gestation to mature the fetal lungs due to risk of preterm delivery.
This is a preventative measure against complications.
When is planned delivery considered for placenta praevia?
Between 36 and 37 weeks gestation to reduce risk of spontaneous labour and bleeding.
Delivery method must be a caesarean section if placenta praevia is present.
What are the methods for managing haemorrhage in placenta praevia?
- Emergency section
- Blood transfusion
- Intrauterine balloon tamponade
- Uterine artery occlusion
- Emergency hysterectomy
These methods are critical for preserving maternal and fetal health.
What does placenta accreta refer to?
When the placenta implants deeper, through and past the endometrium, making it difficult to separate after delivery.
This can lead to significant complications during and after delivery.
What are the classes of placenta accreta spectrum?
- Superficial placenta accreta - implants in surface of myometrium
- Placenta increta - attaches deeply into myometrium
- Placenta percreta - invades past myometrium and perimetrium
Each class indicates a different level of severity and management requirement.
What are the risk factors for placenta accreta?
- Previous placenta accreta
- Previous endometrial curettage procedures
- Previous c-section
- Multigravida
- Increased maternal age
- Low-lying placenta or placenta praevia
Identifying these factors is important for risk assessment.
What are the clinical features of placenta accreta?
- Typically asymptomatic in pregnancy
- May be diagnosed on antenatal ultrasound scans
- Can cause significant postpartum haemorrhage if diagnosed at birth
Awareness of symptoms aids in timely intervention.
What is the management strategy for placenta accreta?
Ideally diagnosed antenatally with planned birth between 35 and 36 weeks gestation to reduce risk of spontaneous labour and delivery.
Early planning is essential for safety.
