Placenta praaevia & accreta GTG + Vasa praevia GTG

Question 1

How common is placenta praaevia?

Answer 1

1 in 200

Question 2

Low lying placenta is how far from internal Os

Answer 2

<20mm

Placenta praaevia lies directly over internal Os

Question 3

How common is placenta accreta?

Answer 3

1 in 300-2000

Question 4

Risk of placenta praaevia after
0 CS

Answer 4

1 in 400 0.24%

Question 5

Risk of placenta praaevia after
1 CS

Answer 5

1 in 160 0.6%

Question 6

Risk of placenta praaevia after
2 CS

Answer 6

1 in 60 1.6%

Question 7

Risk of placenta praaevia after
3 CS

Answer 7

1 in 30 3.3%

Question 8

Risk of placenta praaevia after
4 CS

Answer 8

1 in 10 10%

Question 9

What other factors increase risk of placenta praaevia?

Answer 9

ART
Smoking
< 1 year since CS

Question 10

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

Answer 10

32 weeks
90%

If still present booked 36weeks

Question 11

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

Answer 11

APH and EMCS

Question 12

Main risk with placenta praevia

Answer 12

preterm labour
obstetric haemorrhage

Question 13

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

Answer 13

34-36+6

Question 14

Uncomplicated praevia

Answer 14

36-37weeks

Question 15

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

Answer 15

Pre/intra-op USS

If transverse lie, consider vertical incision

Question 16

If placenta is cut during delivery, what should happen?

Answer 16

Clamp the cord to avoid excessive fetal blood loss

Question 17

Risk of emergency hysterectomy CS for PP

Answer 17

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

Question 18

Need for further surgery following CS for PP

Answer 18

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

Question 19

Risk of thromboembolic disease following CS for praaevia

Answer 19

3/100

Question 20

Risk bladder/ureterc injury CS for praevia

Answer 20

6/100

Question 21

Risk of future placenta praevia

Answer 21

future placenta praevia, 23 in 1000 women (common)

Question 22

Risk MOH for CS for praaevia

Answer 22

future placenta praevia, 23 in 100 women (common)

Question 23

If placenta praaevia and previous CS risk of emergency hysterectomy?

Answer 23

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

Question 24

Risk accreta with placenta praevia after 1CS

Answer 24

3%

Question 25

Risk accreta with placenta praevia after 2CS

Answer 25

11%

Question 26

Risk accreta with placenta praevia after 3 CS

Answer 26

40%

Question 27

Risk accreta with placenta praevia after 4CS

Answer 27

61%

Question 28

Risk accreta with placenta praevia after 5+CS

Answer 28

>67%

Question 29

What % of accreta are not Dx until CS?

Answer 29

1/2 to 1/3

Question 30

Median blood loss with accreta?

Answer 30

2000-7800mls

Question 31

Sensitivity and specificity of USS for Dx accreta?

Answer 31

90% sensitive 96% specificity Confirm with MRI

Question 32

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

Answer 32

35-36 weeks

Question 33

How should the placenta be delivered with placenta accreta?

Answer 33

CS hysterectomy with placenta in situ If shallow invasion can consider partial myometrial resection Leave placenta left in situ

Question 34

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

Answer 34

31% - secondary hysterectomy 4% matneral mortality

Question 35

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

Answer 35

- 73% - 80%

Question 36

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

Answer 36

75%

Question 37

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

Answer 37

Leave placenta in situ Emergency hysterectomy

Question 38

What are Type 1 and Type 2 of Vasa praevia?

Answer 38

Type 1: Velamentous umbilical cord Type 2: Connects placenta with succenturiate or accessory lobe

Question 39

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

Answer 39

60%

Question 40

What % of vasa praevia are Dx antenatally?

Answer 40

95%

Question 41

What is the incidence of vasa praevia?

Answer 41

1/1200-1500

Question 42

Vasa praevia Dx in 2nd trimester, what % resolve by delivery? When should FU scan be booked?

Answer 42

20% 32/40

Question 43

When should asymptomatic women with vasa praevia be delivered?

Answer 43

34-36weeks

Question 44

When should steroids be given?

Answer 44

32 weeks

Question 45

Can consider prophylactic admission to hospital from which gestation?

Answer 45

30-32 weeks

Question 46

If known vasa praevia and SROM?

Answer 46

EMCS