Placenta praevia by Dr. Bijit

1. WELCOME
To
Morning Session

2. TOPIC: PLACENTA PRAEVIA
Presented by:
Dr. Bijit Talukdar
Intern Doctor
Unit-III
Dept. of Obstetrics & Gynaecology

3. PLACENTA PRAEVIA
When the placenta is implanted partially or
completely over the lower uterine
segment, it is called placenta praevia.

4. CAUSES OF PLACENTA PRAEVIA:
Dropping down theory.
Persistence of chorionic activity.
Defective decidua.
Big surface area of the placenta.

5. PREDISPOSING FACTORS :
 Multiparity
 Maternal age: >35 years
 Race: Asian women
 Infertility treatment
 Presence of uterine scar
 Prior curettage
 Prior placenta praevia
 Multiple pregnancy

6. TYPES:
Type-I: Low lying
Type-II: Marginal
-Anterior
-Posterior
Type-III: Incomplete or
partial central
Type-IV: Complete Or
central
Clinically:
Mild degree: I & II ant.
Major degree: II post.
III & IV

7. DANGEROUS TYPE OF PLACENTA PRAEVIA
 Type II posterior placenta praevia
Cause-
1. Because of the curved birth canal major thickness
of placenta overlies the sacral promontory, thereby
diminishing the antero-posterior diameter of the
inlet & prevents engagement of the presenting
part. This hinders effective compression of the
separated placenta to stop bleeding.
2. Placenta is more likely to be compressed if
vaginal delivery is allowed.
3. More chance of cord compression or prolapse
which may produce fetal anoxia or even death.

8. CHARACTERISTICS OF BLEEDING
Small
Painless
Recurrent
Inevitable

9. CAUSE OF BLEEDING:
 Placental growth slows on later months of
pregnancy, but the lower uterine segment
progressively dilates.
 Placenta gets separated due to shearing effect.
 Maternal sinuses become open up
 Bleeding occurs

10. MANAGEMENT OF PLACENTA PRAEVIA
Diagnosis:
Clinical features:
Symptoms: Sudden onset , painless, apparently causeless
& recurrent bleeding.
Signs:
General examination: General condition & anaemia are
proportionate to visible blood loss.
Abdominal Examination:
Size of uterus: proportionate to the period of gestation.
Feel of uterus: Soft, relaxed & elastic without any localised area
of tenderness.
Malpresentaion: Berech or transverse or unstable lie is more
frequent.
Fetal head: High floating
FHS: Usually present

11. Vulval inspection:
To see whether the bleeding is still occurring or not.
Character of blood: Bright red
Investigation:
Confirmation of diagnosis: USG of Pregnancy profile
Others:
Hb%
Blood grouping & Rh typing & cross matching
RBS

12. TREATMENT:
Expectant treatment:
1. Hospitalization
2. Wide bore IV cannula
3. IV fluid
4. Blood transfusion after grouping & cross matching
5. Iron & folic acid
6. Catheterization
7. Close follow up

13. DEFINITIVE TREATMENT:
Termination of pregnancy.
According to the type of placenta praevia:
A) Type I & Type II anterior: Normal vaginal delivery (
If maternal & fetal condition is good)
B) Type II posterior, Type III & Type IV: Caesarean
section

14. COMPLICATIONS:
Maternal Complication:
During pregnancy:
1. APH with varying degrees of shock.
2. Malpresentation
3. Premature labour
During labour:
1. Early rupture of membrane
2. Cord prolapse
3. Intrapartum Haemorrhage
4. Post partum haemorrhage
5. Retained placenta

15. During Puerperium:
1. Puerperal sepsis
2. Subinvolution
3. Embolism
Fetal Complication:
1. Low birth weight
2. Fetal growth restriction
3. IUFD
4. Asphyxia
5. Birth injury
6. Congenital Malformation

16. THANK YOU