Placenta Praevia and Abruption Flashcards
What is placenta praevia?
Placenta implanted in the uterine lower segment.
Low lying refers to placental site before lower segment formation.
It is a common cause of APH
What are the 4 stages of placenta praevia?
Stage 1:
Low lying placenta within 2cm of the internal os.
Stage 2:
Placental edge reaches but does not cross the internal os.
Stage 3:
Placenta partially covers the internal os.
Stage 4:
Placenta completely covers the internal os.
What are the risk factors for having placenta praevia?
Twins High parity Increased maternal age Previous placenta praevia Smoking
What are the complications of placenta praevia?
APH
Abnormal lie
Caesarean section
- Placenta acreta (placental villi attach to the uterine wall)
- Placenta percreta (placenta penetrates through the uterine wall)
*Serious complications can cause huge maternal bleeds associated with maternal mortality
How would a APH caused by placenta praevia present?
Painless
Bright red vaginal bleeding
Often in third trimester
Shock consistent with loss (shock is not common)
How should you manage a patient with placenta praevia antenatally?
If low lying placenta, confirm placenta praevia @ 32week USS.
If placenta is anterior and under a previous C-section scar:
3D USS to look for placenta acreta
If bleeding: admit to hospital and keep until delivery, give anti-D if indicated, maintain IV access consider steroids if less than 34 weeks
If bleeding during presentation to labour: Continuous CTG + blood count, clotting studies and x match.
If asymptomatic: admit at 37 weeks or delay admission until delivery if easy access to hospital
How should you manage a patient with placenta praevia intrapartum?
If stage 1 can deliver vaginally.
If major placenta praevia deliver by elective c-section at 38 weeks.
If placenta acreta is suspected (anterior placenta praevia in a lady with a previous c-section). Elective c-section at 36-37 weeks. Uterine incision away from placenta, prepare for massive haemorrhage, hysterectomy may be indicated in massive haemorrhage.
If a lady with placenta praevia has an APH what mustn’t you do?
A vaginal examination as can increase bleeding.
What advice should be given to a women with stage 2,3,4 placenta praevia?
Avoid penetrative sex as can cause bleeding.
What is placental abruption?
Premature seperation of the placenta from the uterine wall
How does placental abruption present?
Lower abdominal pain
*Dark red blood loss (port discolouration of amniotic fluid)
Shock inconsistent with bleeding (concealed)
Tender uterus (may be hard)
Fetal heart rate may show distress or be absent
*Note: blood may not be present may all be concealed.
What are risk factors of developing abruption?
Pre-eclampsia
Multiple pregnancy
IUGR
High parity and advancing age
Past history of abruption
Smoking and cocaine use
What are the complications of abruption?
Fetal death
Congenital abnormalities and IUGR more common (not caused by abruption but co-exist)
Haemorrhage can lead to DIC resulting in renal failure and potentially maternal death
How should you manage placental abruption?
USS to rule out placenta praevia if diagnosis uncertain
Mother: ABC Bloods: FBC, coag, x match Give blood/IV fluids Catheterise and measure UO Give anti-D if indicated
Foetus:
CTG
If distressed urgent delivery by CS
If not distressed:
If greater than 37 weeks gestation induce labour, continuous monitoring with view to c-section if distress
If less than 34 weeks steroids (for lung maturation) close monitoring with view to c-section if ay distress
Plan for PPH
What are the most common causes of APH?
Placental abruption 1% of pregnancies (30% of APH)
Placenta praevia 2% of pregnancies (20% of AP)
Idiopathic bleeding
