placenta praevia

1. PLACENTA PRAEVIA
Presented by:
Naveeda Anjum
M.Sc. (OBG) 1st Year
Baba Farid University

2. INTRODUCTION
 The placenta is implanted partially or
completely over the lower uterine segment it is
called placenta.

3. DEFINITION
 In placenta praevia the placenta is implanted
in the lower uterine segment such that it
completely or partially cover the cervix or is
close enough to the cervix to cause bleeding
when the cervix dilated or the lower uterine
segment effaces.
(Hull and Resnik, 2009)

4. INCIDENCE
 In 80% cases it is found in multiparous
women.
 The incidence is increased beyond the age of
35, with high birth order pregnancies and in
multiple pregnancy.
 The incidence approximately 4-5 per thousand
pregnancies.

5. RISK FACTOR
 Multiparity
 Increased maternal age
 Higher altitude
 History of pervious scar in the uterus
 smoking

6. TYPES
 There are four types of placenta praevia
depending up on the degree of extension of
placenta to the lower segment.
 Type 1 (Low lying)
 Type 2 (Marginal)
 Type 3 (Incomplete or partial central)
 Type 4 (Central or total)

7. CONTD...
 Type 1 (Low lying) :
The major part of the placenta is attached to
the upper segment and only the lower margin
encroaches onto the lower segment but not on
the os.

8. CONTD...
 Type 2 (Marginal):
The placenta reaches the margin of internal os
but does not cover it.

9. CONTD...
 Type 3 (Incomplete or partial central):
The placenta covers the internal os partially
(cover the internal os when closed but does
not entirely do so when fully dilated)

10. CONTD...
 Type 4 (Central or total):
The placenta completely covers the internal os
even after it is fully dilated.

11. CLINICAL FEATURES
 Symptoms
Vaginal bleeding:
 Sudden in onset, painless
 Revealed bleeding (fresh blood)
 Bright red or dark coloured
 Unrelated to activity

12. CONTD...
Signs:
 General conditions and anaemia are
proportionate to the visible blood loss.
Abdominal examination: the size of the uterus
 Uterus feels relaxed and soft.
 The head is floating in contrast to the period of
gestation.
 Fetal heart sound is usually present.

13. CONTD...
 Vaginal inspection:
Placenta is felt on the lower segment.

14. COMPLICATIOINS
Complications of placenta praevia:
1. Maternal complications:
 During pregnancy
 During labour
 Puerperium
2. Fetal complications

15. MATERNAL COMPLICATIONS
 Druing pregnancy:
 Antepartum haemorrhage
 Malpresentation
 Premature labour

16. CONTD...
 During labour:
 Early repture of membranes
 Cord prolapse
 Slow dilation of the cervix
 Intrapartum haemorrhage

17. CONTD...
 Puerperium:
 Postpartum haemorrhage
 Retained placenta
 suvinvolution

18. FETAL COMPLICATION
 Low birth weight
 Asphyxia
 Intreuterine death

19. DIAGNOSIS
 Placentagraphy:
Sonography
Colour dopler flow study
Magnetic resonance
Vaginal examination

20. MANAGEMENT
 Prevention
 Immediate management
 Expectant management
 Active management
 Nursing management

21. PREVENTION
To minimize the risks, the following guidelines are
useful.
 Adequate antenatal care.
 Significance of warning haemorrhage
At home-
 Put the patient on bed
 Abdominal examination
 Vaginal examination must not be done
Transfer to hospital
 Admission to hospital

22. IMMEDIATE ATTENTION
 To ensure an adequate blood supply to a
women and fetus place the women immediatly
on bed rest in a side lying position.
 A large bore IV cannula is cited and infusion
of normal sline
 Gentle abdominal palpation

23. SCHEME OF MANAGEMENT
 All APH patients are to be admitted
- general and abdominal examination
- Clinical assessment of blood loss
- Resuscitation if necessary
- Localisation of placenta
1.Excpectant management 2. Active interference

24. EXPECTANT MANAGEMENT
The expectant management is carried upto 37
weeks.
Aim: The aim is to continue pregnancy for fetal
maturity without compromising the maternal
health.
Indications:
 No active bleeding
 Patient stable haemo-dynamically
 FHS-good
 CTG-reactive fetus

25. CONTD...
 Interventions:
 Bed rest
 Periodic inspection of vulvul pads
 Supplementary haematinics if patient is
anaemic
 Use of tocolytics
 Rh immunoglobulins to all Rh negative
women

26. ACTIVE MANAGEMENT
Indications:
 Bleeding occurs at or after 37 weeks of
pregnancy
 Patient is in labour
 FHS- absent
 Gross fetal malformation
 Dead fetus

27. CONTD...
Active management
Vaginal delivery Caesarean delivery
Placental edge is within 2cm from the internal
os: in this case no internal examination is
performed and caesarean section is considered
as the best choice.

28. NURSING MANAGEMENT
Nursing diagnosis:
Decreased cardiac output related to blood loss
as manifested by increase in heart rate.
Interventions:
 Monitor vital signs
 Provide adequate rest
 Encourage relaxation techniques
 Evaluate Hb of the client

29. Ineffective tissue perfusion related to
decrease in Hb in blood as menifested by
dyspnea.
Interventions:
 Monitor vital signs
 Encourage quiet and restful environment
 Encourage use of relaxation techniques
 Provide supplemental oxygen to the client as
prescribed by the physician.

30. Deficient fluid volume related to blood
loss as manifested by vital signs
changes.
Interventions:
 Monitor vital signs.
 Monitor FHR.
 Initiate IV fluids as ordered by the physician.
 Place the patient in left lateral position.

31. THANK YOU