Placenta_Praevia_Flashcards
What is the definition of placenta praevia?
Placenta praevia is when the placenta lies directly over the internal os.
What is the definition of low-lying placenta?
Low-lying placenta is when the placental edge lies less than 2 cm from the internal os.
What is the management for asymptomatic low-lying placenta or placenta praevia identified at 20 weeks?
Advise to avoid sex, rescan at 32 weeks gestation. If still low-lying/praevia at 32 weeks, rescan at 36 weeks.
What should be done if a low-lying placenta or placenta praevia is still present at 32 weeks?
If still low-lying/praevia at 32 weeks, rescan at 36 weeks.
What is the recommended delivery plan if placenta praevia is still present at 36 weeks?
If still low-lying/praevia at 36 weeks, recommend elective C-section at 36-37 weeks gestation.
What is the initial management for symptomatic placenta praevia with painless bleeding?
Use the ABCDE approach: gain IV access, take bloods (FBC, Rhesus status, cross-match, clotting screen), and perform continuous fetal monitoring.
What should be done for Rh-negative women with symptomatic placenta praevia?
Give anti-D immunoglobulin in Rh-negative women.
What is the delivery decision based on the mother’s haemodynamic status and fetal distress in symptomatic placenta praevia?
If the mother is haemodynamically unstable or there is evidence of fetal distress, perform an emergency C-section irrespective of gestation. If stable with no fetal distress, give steroids, admit until bleeding stops, observe for 48 hours, and rescan at 36 weeks.
What are the risk factors for placenta praevia?
Risk factors include previous placenta praevia, multiple pregnancy, previous C-section, smoking and drug use, and advanced maternal age.
What are the key points to explain to a patient presenting with asymptomatic low-lying placenta or placenta praevia?
Explain the importance of the finding and that it increases the risk of bleeding. Reassure that no need to limit activity or intercourse unless active bleeding. Explain that 9 out of 10 placentas will move away from the os by the follow-up scan, and only 1 in 200 will have placenta praevia at the end of pregnancy. Rescan at 32 weeks and then at 36 weeks if still present.
What are the key points to explain to a patient presenting with symptomatic placenta praevia with bleeding?
Admit until bleeding has stopped and for a further 48 hours. Explain the importance of the finding and that the fetus needs to be monitored. Discuss prompt delivery based on gestation. Explain the risks of delivery, including major blood loss, potential need for a blood transfusion, and possible hysterectomy.
