20140110221000527

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Placenta

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20140110221000527

  1. 1. Placenta previaPlacenta previa Placental abruption Women’s Hospital School of MedicineWomen’s Hospital School of Medicine Zhejiang UniversityZhejiang University Wang ZhengpingWang Zhengping
  2. 2. Antepartum Hemorrhage • Third-trimester bleeding Obstetric: Placental separation Placental Previa Placenta Abruption Uterine Rupture vasa previa : Fetal Vessel Rupture No obstetric: Acute vaginitis/cervicitis, Cervical polyp, Cervical cancer, Trauma
  3. 3. Placenta previaPlacenta previa
  4. 4. Definition • Placenta previa: The inferior edge of placenta load at the lower uterine segment, or even reach the internal cervical os after 28 weeks gestation. • Incidence rate: Internal : 0.24%~1.57% ; International : 0.5%~0.9% 。
  5. 5. Etiology • High-risk group  Age of gravida>35  Multipara  Pregnancy women used to tobacco or dope • Initial etiologic agnet  Damage of endometria  Development of the trophoblastic layer of fertilized ovum delayed  Anomaly of placenta  Cicatricial uterus due to cesarean section ,e.g.
  6. 6. Classification  Classified according to the relationship between the edge of placenta and the internal cervical os : complete ( central ) placenta previa partial placenta previa marginal placenta previa  Time to determine classification : the last examination before managed
  7. 7. (1) complete placenta previa (2) partial placenta previa (3) marginal placenta previa
  8. 8. Classification Types of placenta previa.
  9. 9. Clinical Features  Painless 、 recurrent vaginal bleeding in the second or third trimester of pregnancy  Anemia,shock or even death corresponded to the volume of vaginal bleeding  The uterus is usually soft and relaxed  Anomaly of fetal condition  Per vagina examination
  10. 10. • Total placenta previa • Early(20- 28wks) • Large amount • Several times Partial placentaPartial placenta previaprevia Between totalBetween total and marginaland marginal Marginal placenta previa Late(37-40WKS or in labor ) Less bleeding Bleeding time and volume Central placenta previa Early(20-28wks) Large amount Several times Partial placentaPartial placenta previaprevia Between total andBetween total and marginalmarginal Marginal placenta previa Late(37-40WKS or in labor ) Less bleeding
  11. 11. Auxiliary examination  B-ultrasound examination  Placenta examination post partum <7cm  MRI
  12. 12. marginal placenta previa
  13. 13. partial placenta previa
  14. 14. central placenta previa
  15. 15. Differential diagnosis • Placental abruption • Disruption of vasa previa • Cervical polyp or erosion • Cancer of cervix
  16. 16. Complication of mother and fetus Bleeding at or post partum  Implantation of placenta  Anemia and puerperal infection  Premature delivery
  17. 17. Implantation of placenta
  18. 18. Management  expectant treatment  Indication: Fewer vaginal bleeding Patient’s condition stabilization <36 weeks gestation, fetal weight<2300g  Management: Lying in bed to take a rest Inhibition of uterine contraction Treatment aim at symptoms Promote development of fetus Prevention of infection
  19. 19.  Termination of pregnancy Indication: 1.Severe vaginal bleeding 2.Gestation age >36 weeks, or fetal lung function been matured Mode of labor:According to the type of placenta previa,volume of vaginal bleeding and condition of gravia, et al. Cesarean delivery is necessary in practically all women with placental previa
  20. 20.  Transport in emergency condition In the neighborhood Initiatory management
  21. 21. Placental abruption
  22. 22. Definition Placental abruption: placenta in normal site strip from the uterine parietal partially or completely before the fetus expulsion,after 20 weeks gestation or in the delivery procedure. Incidence rate: 0.46%~2.1% Neonatal mortality: 200‰~428‰
  23. 23. Etiology  Angiopathy of vasa basalis  Mechanical agent  Venous pressure of uterus elevated abruptly  Volume of uterus deflated abruptly  Others: Age of gravida>35,multipara, tobacco,dope
  24. 24. Classification  Classify according to vaginal bleeding or nor: Dominant/Recessive/Mixed  Classify according to severity degree: Light type < 1/3 Severe type > 1/3; > 1/2, Dead fetus
  25. 25. Uteroplacental apoplexy: widespread extravasation of blood into the uterine musculature and beneath the uterine serosa
  26. 26. Clinical Features  Abruptly,persistent abdominal pain with vaginal bleeding  Maternal compromise/ shock(Volume of vaginal bleeding not correspond to patient condition)  Anomaly of fetal condition  The uterus touched hard with pain  The size of uterus is bigger than it should be in that gestation age
  27. 27. Auxiliary examination Diagnotic examination: B-ultrasound examination Placenta examination post partum Blood Rt,Blood coagulation,blood examination of hepatic and renal function
  28. 28. Sonography
  29. 29. Differential diagnosis • Placental previa • Uterus rupture
  30. 30. Complications DIC,dysfunction of coagulation Post partum hemorrhagic/shock Amniotic fluid embolism Acute renal failure Fetal death
  31. 31. Management Treatment depends on: • Condition of the mother and fetus • Gestational age of the fetus • Cervical examination Principle: If diagnosed,fetus will be deliveried immediately
  32. 32. Management Mature fetus Deliver Compromised mother Deliver Immature fetus Expectant, if mother stable
  33. 33. Expectant Management • Bed rest • Ongoing maternal monitoring • Fetal assessment: age, growth, well being • Deliver if recurrent signs / symptoms • Deliver at fetal maturation
  34. 34. Severe placental abruption: • Resuscitation • Evaluate and treat coagulation defect • Deliver the fetus: Cesarean section • Prevention of PPH • Monitor renal status closely

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