placenta pravia

Question 1

what is placenta praevia

Answer 1

Placenta praevia (PP) is defined as the placenta overlying the cervical os.

Question 2

classic presenation

Answer 2

bleeding after 24 weeks
bright red vaginal bleeding which is painless.
shock is severe

Question 3

investigation of choice

Answer 3

If there is painless bleeding after 13 weeks or previous history of uterine incision, then transvaginal ultrasound should be used to exclude placenta praevia
A further ultrasound should be carried out at 37 weeks to reassess the placental position

Question 4

mx Bleeding with unknown placental position:

stable
not stable

Answer 4

ABC approach, resuscitation and stabilisation
If stable, perform urgent ultrasound
If the bleeding is not controlled, immediate caesarean section required

Question 5

Bleeding with known placenta praevia:

Answer 5

ABC approach, resuscitation and stabilisation. If stabilisation is not achieved, send for emergency caesarean Section.
Corticosteroids should be considered if between 24-34 weeks gestation and there is risk of preterm labour

Question 6

if in labour with pp what do you do

Answer 6

c section
Placenta praevia with no bleeding and not in labour:

Monitor with ultrasound scans
Give advice about pelvic rest (no penetrative sexual intercourse) and advise to go to hospital if there is significant vaginal bleeding

elective at term 37-38
When the placental edge is greater than 20mm from the internal cervical os, women can be offered a trial of labour (if no bleeding and with careful intrapartum monitoring). If significant haemorrhage or foetal distress develops during trialled vaginal delivery, immediately take to theatre for caesarean section.