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Placenta Previa

Placenta previa is a condition where the placenta implants in the lower uterine segment, either fully or partially covering the internal os. Risk factors include increased maternal age, multiparity, prior cesarean delivery, smoking, and elevated MSAFP levels. Clinical features may include painless bleeding, either minimal initially or becoming profuse. Management depends on gestational age and bleeding, ranging from close observation to scheduled C-section to hysterectomy for placenta accreta. Complications include increased perinatal mortality and morbidity due to preterm delivery and hypovolemic shock.

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Jorge De Vera
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207 views2 pages

Placenta Previa

Placenta previa is a condition where the placenta implants in the lower uterine segment, either fully or partially covering the internal os. Risk factors include increased maternal age, multiparity, prior cesarean delivery, smoking, and elevated MSAFP levels. Clinical features may include painless bleeding, either minimal initially or becoming profuse. Management depends on gestational age and bleeding, ranging from close observation to scheduled C-section to hysterectomy for placenta accreta. Complications include increased perinatal mortality and morbidity due to preterm delivery and hypovolemic shock.

Uploaded by

Jorge De Vera
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Definition

PLACENTA PREVIA
Previa- going before; Placenta goes before the fetus into birth canal
Placenta is implanted in the lower uterine segment
Placental migration- movement of the placenta away from the internal
os.
o Migration- misnomer
Trophotropism- placental growth toward the fundus because of greater
upper uterine blood flow
Low lying placenta is less likely to migrate within a uterus with a prior
cesarean hysterotomy scar

Classification

Totalis- internal os is completely covered by placenta


Partialis- internal os is partially covered by placent
Marginalis- placenta is at the EDGE of internal os but did not overlie it
Low lying- placental does not reach the internal os and remains outside
(2 cm)

Risk factors

Increased maternal age


Multiparity
Prior cesarean deliviery
Cigarette smoking
Elevated MSAFP level
Painless bleeding- most characteristics

Clinical features

-profuse vaginal bleeding


-or initially minimal profuse bleeding

History

Abdominal Exam

Sentinel bleed- bleeding without warning/ pain


(-) pre eclampsia
Repeated warning hemorrhage
(-) abdominal pain

(-) tenderness
Normal uterine tone
Rarely in labor
Malpresentation is common
Fetal parts are usually palpable
(+) fetal heart tones
If bleeding is minimal, you cant appreciate deteriorating maternal and
fetal status
If profuse bleeding: deteriorating status
Uterus: soft

Ultrasound
MRI
Vaginal Examination

Placenta in lower uterine segment


- Transvaginal= most definitive
- MRI- for placenta accreta
Double setup reveals placenta implanted in lower uterine segment

Management

1. CLOSE OBSERVATION- preterm + no persistent bleeding


2. SCHEDULED ULTRASOUND- near term + not bleeding
Vertical incision- recommended
Low transverse hysterotomy- will cause bleeding if there is
an anterior placenta
3. HYSTERECTOMY- placenta accrete syndrome
4. PRESSURE 0-Chromic suture PELVIC ARTERY EMBOLIZATION
- For poorly contracted uterus
- uncontrollable hemorrhage after placental removal
General rule: Cesarean section except:
-low lying placenta
-marginalis
-anteriorly located placenta
Safe to deliver at 34-35 weeks: lung maturation is developed

Complications

NOTES

Increased perinatal mortality and morbidity


-most of the time secondary to preterm delivery
Hypovolemic shock
1. Dont do DIGITAL PALPATION- usually causes severe hemorrhage!!
2. VASA PREVIA- fetal vessels course through membrane & present at
the cervical os
3. SMOKING- increased the risk of placenta previa (2 fold)
4. PLACENTA ACCRETE SYNDROME- accrete, increta & percreta (ALAM
MO NIYO NA TO)
- Previa + Prior cesarean= high risk for accrete
5. Placenta previa is RARELY complicated by coagulopathy
6. Transabdominal sonography- imprecise results due to bladder
distention and large fundal placenta is not appreciated
7. Transvaginal UTZ- Superior
8. Transperineal UTZ= accurate to localize previa
9. WALANG MAGTOTOCOLYTICS sabi ni doc
10. Preterm delivery- major cause of perinatal death

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