Placental Problems Flashcards
What is placenta praevia?
placenta is partially or totally implanted in the lower uterine segment
How is placenta praevia classified?
USS
Describe major placenta praevia.
Placenta lies over internal cervical os
Describe minor/partial placenta praevia.
Leading edge of placenta in lower uterine segment but not covering os
What are some risk factors for placenta praevia?
strong:
uterine scarring (prior c section)
infertility treatments
previous placenta praevia
weak:
previous TOP or miscarriage
>40 years
How does placenta praevia usually present?
Painless bleeding >24 weeks
Minor to severe
What can trigger the bleeding in placenta praevia?
Sex (however its usually unprovoked)
How is placenta praevia diagnosed?
transvaginal USS
DONT PERFORM VAGINAL EXAM UNTIL EXCLUDED
How is placenta praevia treated?
assess fetal wellbeing, monitor HR
may need major haemorrhage protocol
C section
resus and stabilisation
What is placenta accreta?
Placenta is abnormally adherent to uterine wall
What are risk factors for placenta accreta?
multiple C sections
placenta praevia
How does placenta accreta present?
severe bleeding
PPH
What does placenta accreta usually required?
hysterectomy
What is placental abruption?
separation of a normally implanted placenta - partially or totally before birth of the foetus
What does the outcome depend on in placental abruption?
amount of blood loss and degree of separation
What are the main risk factors for placental abruption?
hypertension cocaine use pre eclampsia smoking previous abruption oligohydramnios
What are the signs and symptoms of placental abruption?
severe abdominal pain
vaginal bleeding
uterine contractions and tenderness
woody, hard uterus
What is the CTG like in placental abruption?
loss of variability, decelerations
What is the treatment of placental abruption
stabilisation of mother - blood and fluid replacement
monitoring of mother and foetus
delivery - c section
What are the maternal complications of placental abruption?
hypovolaemic shock DIC anaemia PPH coagulopathy renal failure infection thromboembolism
What are the foetal complications of placental abruption?
IUD
hypoxia
prematurity
small for gestational age and fetal growth restriction
What is vasa praevia?
Unprotected fetal vessels traverse fetal membranes over internal cervical os
When are the vessels at risk of damage in vasa praevia?
rupture of membranes
What is the main risk in vasa praevia?
fetal haemorrhage
How is the baby delivered in vasa praevia?
c section
How is vasa praevia diagnosed?
USS
