Placental praevia Flashcards
What is placenta praevia?
Where the placenta is fully or partially attached to the lower uterine segment
What is antepartum haemorrhage an important cause of?
Antepartum haemorrhage
Name the two main types of placenta praevia
Minor placenta praevia
Major placenta praevia
Describe minor placenta praevia
Placenta is low but does not cover the internal cervical os
Describe major placenta praevia
Placenta lies over the internal cervical os
What is a low lying placenta more susceptible to?
Haemorrhage
What can bleeding from placenta praevia result from?
Spontaneous or provoked by mild trauma or from the presenting part of the foetus moving into the lower uterine segment in preparation for labour
List the risk factors for placenta praevia
Previous caesarean section
High parity Maternal age >40 Multiple pregnancy Previous placenta praevia History of uterine infection Curettage to the endometrium after miscarriage or termination
List the clinical features of placenta praevia
Antepartum haemorrhage
Painless vaginal bleeding - from spotting to massive haemorrhage.
There can be pain if woman is in labour
What might examination of placenta praevia revel?
Risk factors of placenta praevia such as c-section scars or multiple pregnancy
The uterus is usually not tender on palpation
List the differentials of placenta praevia
Placental abruption
Vasa praevia
Uterine rupture
Local genital causes - benign/malignant lesions/ infections
What investigations should be performed for placenta praevia
Bloods - FBC, clotting, Kleihauer test, group and save, crossmatch, U&Es, LFTs
Foetal wellbeing - CTG if >26 weeks gestation
Imaging - USS
What is seen on USS in placenta praevia
Lower edge of placenta and internal os
Describe the management of placenta praevia
Major haemorrhage - ABCDE approach
Major - repeat scan at 32 weeks and plan for delivery
Minor - repeat scan at 36 weeks as placenta is likely to have moved superiorly
When might placenta praevia be detected antenatally
20 week ultrasound scan
