topic list placenta previa(1)

7/25/2019 Topic List Placenta Previa(1)

1/22

Placenta PreviaSupervised by:

dr. Pim Gonta, Sp.OG

Compiled by:

Sherynne Sulaiman 2013.061.081

Kent Pradana 2014.061.131

Emily 2014.061.132

Mar ha !e i"a #r anta 2014.061.136


2/22

!e$nition

After 28 pregnant weeks placental implantation over the cervicalostium or in the lower uterine segment

It constitutes an obstruction of descent of the presenting part

Main cause of obstetrical hemorrhage 2!"#

Incidence: !$2%"&'$()"


3/22

Epidemiolo%y *S: occur in !$+&!$(" of all *S pregnancies Incidence: 2$8 per '!!! live births ,revalence rate of placenta previa - %$! per '!!!births:. *SA&based studies %$( per '!!! births#. /oreign&based studies +$) per '!!! births#


4/22

&i ' (a"tor ) # o"iation

,rior cesarean delivery0myomectomy risks increase '$(& to (& ,rior myomectomy

,rior previa %&8" recurrence risk#

,revious or recurrent abortion

Abnormal presentation

Advancing maternal age 1+( y# Multiparity (" in grand multiparous patients# Multiple gestation


5/22

&i ' (a"tor ) # o"iation

Short interpregnancy interval ,revious uterine surgery uterine insult or in3ury

Infertility treatment

4onwhite ethnicity

5ow socioeconomic status

Smoking

Cocaine use


6/22

Etiolo%y

Endometrial a*normality. Scared or poorly vasculari6ed endometrium in the corpus$. Curettage 7elivery CS and infection of endometrium

Pla"ental a*normality

. 5arge placenta multiple pregnancy# succenturiate lobe !elayed de+elopment o tropho*la t


7/22

Classification

CompletePlacenta Previ

Partial PlacentaPrevia

MarginalPlacenta Previa


8/22

Symptom Painle +a%inal *leedin%- 0/

. Spontaneous After coitus

. he most characteristicsymptom

. 5ate pregnancy after the 28thweek# and delivery

.Characteristics: sudden painlessand profuse

ontra"tion o ymptom

. 9outine ultrasound nding

#nemia or ho"' . 9epeated bleeding ; anemia.


9/22

Phy i"al (indin%

=leeding on speculum e>am Cervical dilation

Abnormal position0lie

4on&reassuring fetal status

If signi cant bleeding:. achycardia. ,ostural hypertension. Shock


10/22

!ia%no i i tory

. ,ainless hemorrhage

. At late pregnancy or delivery

. ed and nontender$. Contraction may be palpated$. A high presenting part can?t be pressed into the pelvic

inlet$ =reech presentation. /etal heart tones maybe disappear shock or abruption#


11/22

!ia%no i Spe"ulum e amination

. 9ule out local causes of bleeding such as cervical erosion or polypor cancer$

5imited +a%inal e amination - eldom u ed. ,alpation of the vaginal fornices to learn if there is an intervening

bogginess between the forni> and presenting part$


12/22

!ia%no i ltra ound

. Abdominal @(" accurate to detect

. ransvaginal *S# will detect almost all. Consider what placental location a *S may

nd that was missed on abdominal. ransperineal accurate to locali6e placenta previa

M&7 to visuali6e placental abnormality includingprevia

he"' the pla"enta and mem*rane a terdeli+ery


13/22

!i erential !ia%no i

Pla"ental #*ruption. agina bleeding with pain

tenderness of uterus$

9a a Pre+ia. In cases of velamentous cord

insertion fetal vessels covercervical os$

#*normality o er+i. Cervical erosion or polyp or cancer$


14/22

:reatment

E pe"tant therapy. 9est: keep the bed. Controlling the contraction:

MgSB%. reatment of anemia. ,reventing infection

:ermination o pre%nan"y. ae arean Se"tion. otal placenta previa +

week# ,artial placentaprevia +)th week# andheavy bleeding with shoc

. 9a%inal deli+ery. Marginal placenta previa. aginal bleeding is limite


15/22

M# #GEME :

7epends on:. amount of uterine bleeding. duration of pregnancy and viability of the fetus. degree of placenta previa. presentation position and station of the fetus.

gravidity and parity of the patient. status of the cervi>


16/22

Mana%ement

Initial evaluation0diagnosis Bbserve0admit to labor and delivery

I access routine maybe serial# labs

Continuous electronic fetal monitoring. Continuous at least initally

. May re&evaluate later if stable no further bleeding 7elivery


17/22

Mana%ement

5e than 36 ;' %e tation < e pe"tant mana%ement i ta*le,rea urin%. =ed rest negotiable#. 4o vaginal e>ams not negotiable#. Steroids for lung maturation D+2 wks#. ,ossible management at home after 'st bleed. )!" will have recurrent vaginal bleeding before + completed weeks

reEuiring emergent cesarean 36= ;ee' %e tation

. Cesarean delivery if positive fetal lung maturity by amniocentesis

. 7elivery vs e>pectant management if fetal lung immaturity

. Schedule cesarean delivery at +) weeks

. 7iscussion0counseling regarding cesarean hysterectomy

ote>materrea

tatumana%uidea* olO* te

un?


18/22

!eli+ery. e arean Se"tion delivery method of choice with placenta previa$. Most often a transverse uterine incision is possible. =ecause of the poorly contractile nature of the lower uterine segment

there maybe unconbtrollable hemorrhage following placental removal


19/22

9a%inal !eli+ery aginal delivery ; marginal implantation

; cephalic presentation$

G limited vaginal bleeding B>ytocin ; before amniotomy

amponade Monitoring /


20/22

OMP57 #:7O S

,uerperal infection and anemia are the most likely postoperativecomplications$


21/22

P&OG OS7S

Meternal :Mortality has fallen DD ' in '!!!. rapid recourse to cesarean section. banked blood and. e>pertly administered anesthesia

/etal: ,erinatal mortality rate

. placenta previa has declined to appro>imately '"$. reduced if ideal obstetric and newborn care is given$


22/22

hank Hou

topic list placenta previa(1)

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