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MRCOG Antenatal Part 2 Revision - Hay > Placenta praaevia & accreta GTG + Vasa praevia GTG > Flashcards

Placenta praaevia & accreta GTG + Vasa praevia GTG Flashcards

1
Q

How common is placenta praaevia?

A

1 in 200

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2
Q

Low lying placenta is how far from internal Os

A

<20mm

Placenta praaevia lies directly over internal Os

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3
Q

How common is placenta accreta?

A

1 in 300-2000

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4
Q

Risk of placenta praaevia after
0 CS

A

1 in 400 0.24%

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5
Q

Risk of placenta praaevia after
1 CS

A

1 in 160 0.6%

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6
Q

Risk of placenta praaevia after
2 CS

A

1 in 60 1.6%

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7
Q

Risk of placenta praaevia after
3 CS

A

1 in 30 3.3%

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8
Q

Risk of placenta praaevia after
4 CS

A

1 in 10 10%

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9
Q

What other factors increase risk of placenta praaevia?

A

ART
Smoking
< 1 year since CS

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10
Q

When to offer repeat USS? What % will resolve by term?

A

32 weeks
90%

If still present booked 36weeks

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11
Q

Cervical length under 25mm is a predictor of what in praaevia?

A

APH and EMCS

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12
Q

Main risk with placenta praevia

A

preterm labour
obstetric haemorrhage

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13
Q

Placenta praecvia and Hx of bleeding +/ risk of preterm delivered

A

34-36+6

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14
Q

Uncomplicated praevia

A

36-37weeks

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15
Q

What factors can be used to avoid cutting through placenta at CS?

A

Pre/intra-op USS

If transverse lie, consider vertical incision

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16
Q

If placenta is cut during delivery, what should happen?

A

Clamp the cord to avoid excessive fetal blood loss

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17
Q

Risk of emergency hysterectomy CS for PP

A

emergency hysterectomy, up to 11 in 100 women (very common)

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18
Q

Need for further surgery following CS for PP

A

● need for further laparotomy during recovery from the caesarean, 75 in 1000 women (common)

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19
Q

Risk of thromboembolic disease following CS for praaevia

A

3/100

20
Q

Risk bladder/ureterc injury CS for praevia

A

6/100

21
Q

Risk of future placenta praevia

A

future placenta praevia, 23 in 1000 women (common)

22
Q

Risk MOH for CS for praaevia

A

future placenta praevia, 23 in 100 women (common)

23
Q

If placenta praaevia and previous CS risk of emergency hysterectomy?

A

● emergency hysterectomy, up to 27 in 100 women (very common)

24
Q

Risk accreta with placenta praevia after 1CS

A

3%

25
Q

Risk accreta with placenta praevia after 2CS

A

11%

26
Q

Risk accreta with placenta praevia after 3 CS

A

40%

27
Q

Risk accreta with placenta praevia after 4CS

A

61%

28
Q

Risk accreta with placenta praevia after 5+CS

A

> 67%

29
Q

What % of accreta are not Dx until CS?

A

1/2 to 1/3

30
Q

Median blood loss with accreta?

A

2000-7800mls

31
Q

Sensitivity and specificity of USS for Dx accreta?

A

90% sensitive
96% specificity

Confirm with MRI

32
Q

In RF for preterm delivery, when are placenta accreta spectrum delivered?

A

35-36 weeks

33
Q

How should the placenta be delivered with placenta accreta?

A

CS hysterectomy with placenta in situ

If shallow invasion can consider partial myometrial resection

Leave placenta left in situ

34
Q

If partial myometrial resection performed for accreta, what are the risks of:
- Secondary hysterectomy
- Mat mortality

A

31% - secondary hysterectomy
4% matneral mortality

35
Q

If partial myometrial resection performed for accreta, what are the chances of:
- subsequent pregnancy
- subsequent menstruation

A
  • 73%
  • 80%
36
Q

If placenta left in situ and closed, what is the rate of spontaneous reabsorption?

A

75%

37
Q

If unsuspected placenta accreta performed after delivery of baby, what should you do?

A

Leave placenta in situ
Emergency hysterectomy

38
Q

What are Type 1 and Type 2 of Vasa praevia?

A

Type 1: Velamentous umbilical cord

Type 2: Connects placenta with succenturiate or accessory lobe

39
Q

If ruptured vasa praevia, what is the fetal mortality rate despite EMCS?

A

60%

40
Q

What % of vasa praevia are Dx antenatally?

A

95%

41
Q

What is the incidence of vasa praevia?

A

1/1200-1500

42
Q

Vasa praevia Dx in 2nd trimester, what % resolve by delivery?

When should FU scan be booked?

A

20%

32/40

43
Q

When should asymptomatic women with vasa praevia be delivered?

A

34-36weeks

44
Q

When should steroids be given?

A

32 weeks

45
Q

Can consider prophylactic admission to hospital from which gestation?

A

30-32 weeks

46
Q

If known vasa praevia and SROM?

A

EMCS

MRCOG Antenatal Part 2 Revision - Hay (72 decks)

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