Placenta praevia Flashcards

1
Q

Definition

A

Where the placenta is attached to the lower portion of the uterus, lower than the presenting part of the foetus.

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2
Q

Low lying placenta definition

A

Where the placenta is withitn 20mm of internal cervical os.

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3
Q

Placenta praevia definition

A

Only when the placenta is over the internal cervical os.

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4
Q

Risk factors

A
  • Previous caesarean sections
  • Previous placenta praevia
  • Older maternal age
  • Maternal smoking
  • Structural uterine abnormalities (e.g. fibroids)
  • Assisted reproduction (e.g. IVF)
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5
Q

Aetiology of spotting or minor bleeding in pregnancy

A
  • Cervical ectropion
  • Infection and vaginal abrasions from intercourse or procedures
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6
Q

Aetiology of anternatal haemorrhage

A
  • Placenta praevia
  • Placental abruption
  • Vasa praevia
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7
Q

Grades

A
  • Minor praevia, (grade I) = placenta is in lower uterus but not reaching the internal cervical os
  • Marginal praevia, (grade II) – placenta is reaching, but not covering, the internal cervical os
  • Partial praevia, (grade III) = placenta is partially covering the internal cervical os
  • Complete praevia (grade IV) = placenta is completely covering the internal cervical os
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8
Q

Clinical features

A

Many ASx
- May present with painless vaginal bleeding in pregnancy (antepartum haemorrhage).
- Bleeding usually occurs later in pregnancy (around or after 36 weeks).

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9
Q

Diagnosis

A

20-week anomaly scan used to assess the position of the placenta and diagnose placenta praevia.

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10
Q

Treatment

A

For women with low-lying placenta or PP diagnosed in early pregnancy: RCOG recommend TVUS
- 32 weeks gestation
- 36 weeks gestation
Corticosteroids = help mature lungs
Planned delivery between 36-37 weeks to reduce risk of spontaneous labour and bleeding.
Planned c-section = when PP + low lying placenta (<20mm from the internal os)
USS around time of procedure to locate the placenta
Emergancy c-section = premature labour or antenatal bleeding

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11
Q

Complications

A
  • Antepartum haemorrhage
  • Emergency caesarean section
  • Emergency hysterectomy
  • Maternal anaemia and transfusions
  • Preterm birth and low birth weight
  • Stillbirth
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12
Q

Treatment of haemorrhage

A
  • Emergency caesarean section
  • Blood transfusions
  • Intrauterine balloon tamponade
  • Uterine artery occlusion
  • Emergency hysterectomy
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