Placenta previa is a condition where the placenta implants close to or covering the cervical os, which can cause bleeding after 20 weeks of gestation. Risk factors include previous c-sections, uterine surgery, smoking, and fibroids. It is diagnosed via ultrasound and treated by managing bleeding through bed rest, blood transfusions, or c-section for severe cases. After a c-section for placenta previa, patients are monitored closely, kept on bed rest, and follow early solid diet protocols to shorten their hospital stay. They should contact their physician for concerns like fever, low or high blood pressure, heart rate issues, or low urine output.

1. Placenta Previa and discharge of
patients after C-Section
Arisha Batool Zaidi
ROLL NO:51

2. In the name , PREVIA
means FIRST
Placenta is the first thing to develop within
the uterine cavity Therefore , placenta previa
FIGURE shows the normal implantation site
for placenta i .e . the upper uterus

3. ANOMALY=PLACENTA
PREVIA
THE PATHOLOGICAL CONDITION PLACENTA
PREVIA IS SAID TO BE PRESENT WHEN
PLACENTA IMPLANTS CLOSE TO OR EVEN
COVEING THE UTERIVE OPENING CALLED
CERVICAL OS AND IT CAN THEREFORE
USUALLY BLEED,USUALLY AFTER 20 WEEKS
OF GESTATION.

4. CAUSES OF IMPLANTATION IN LOWER UTERUS:
• IT IS UNCLEAR WHY IMPLANTATION OCCURS IN LOWER UTERUS.
• ONE HYPOTHESIS STATES THAT THIS HAPPENS WHEN ENDOMETRIUM
IN UPPER UTERUS IS NOT WELL VASCULARIZED. THIS CAN BE DUE TO
ENDOMETRIAL DAMAGE RESULTING FROM:
~PREVIOUS C-SECTION
~ABORTION(INDUCED OR SPONTANEOUS)
~UTERINE SURGERY
~MULTIPARITY(MULTIPLE PREGNANCIES)

5. OTHER RISK FACTORS:
• OTHER THAN THAT HAVING MUTIPLE PLACENTAS AND PLACENTAS
WITH LARGER THAN NORMAL SURFACE AREA CAN BE REASON,BOTH
OF WHICH CAN SIMULTANEOUSLY OCCUR IN TWINS OR TRIPLETS
• MATERNAL AGE GREATER THAN 35 ALSO INCREASES THE RISK
FACTORS
• INTRAUTERINE FIBROIDS
• MATERNAL SMOKING

6. TYPES OF PLACENTA PREVIA
• 1.COMPLETE
• 2.PARTIAL
• 3.MARGINAL

7. COMPLETE PLACENTA
PREVIA:
IN THIS CONDITION,PLACENTA COMPLETELY
COVERS THE CERVICAL OS

8. PARTIAL PLACENTA
PREVIA
IN THIS CONDITION,PLACENTA PARTIALLY
COVERS THE CERVICAL OS

9. MARGINAL PLACENTA
PREVIA
IN THIS CONDITION,THE EDGE OF PLACENTA
EXTENDS TO WITHIN 2cm OF THE CERVICAL
OS

10. WHY BLEEDING OCCURS
• AS BLEEDING PROGRESSES,LOWER UTERINE SEGMENT
GROWS,GROWTH IN LOWER UTERUS DISRUPTS PLACENTAL BLOOD
VESSELS CAUSING BLEEDING.THE BLEEDING FEATURES AS FOLLOWS:
• IT HAS SUDDEN ONSET AT ABOUT NEARLY A GESTATIONAL PERIOD
OF 20 WEEKS
• IT IS BRIGHT RED IN COLOUR
• IT IS A PAINLESS DISCHARGE
• IT CAN BE INTERMITTENT OR CONTINUOUS
• ITS AMOUNT VARIES.IT ALSO INCREASES DURING LABOUR BECAUSE
OF INCREASING UTERINE CONTRACTIONS AND CERVICAL DILATIONS

11. ASSOCIATED COMPLICATIONS:
• ON MOTHER’S END: DEPENDS UPON THE AMOUNT OF BLOOD LOST
• ON FETAL END:
• HYPOXIA
• PRETERM BIRTH

12. DIAGNOSIS
• PRENATAL ULTRASOUND:EVIDENT,VISUAL ANALYSIS
• OCASSIONALLY,MAY NOT BE RECOGNISED UNTIL CERVICAL CHANGES
DURING LABOUR CAUSE BLEEDING TO HAPPEN

13. TREATMENT/MANAGEMENT
• GOAL IS TO PREVENT PRETERM BIRTH,CONTROL AND MANAGE
BLEEDING
• CORTICOSTEROIDS ARE GIVEN TO ENHANCE FETAL LUNG MATURITY
TO PREVENT HYPOXIA
• MINOR BLEEDING:MANAGED WITH BED REST.TURNS OUT TO BE
SUFFICIENT
• MAJOR BLEEDING:BLOOD PRODUCTS AND INTRAVENOUS THERAPY
• SEVERE CASES:MATERNAL HEMODYNAMICS ARE CRITICALLY
HIGH,FETAL HEART RATE TRACING SHOWS SIGNS OF FETAL
HYPOXIA,IMMEDIATE C-SECTION IS THEN PERFORMED

14. CARE OF PATIENT AFTER C-SECTION
• Monitor intakes and outputs every 4 hours for 24 hours
• Activity:
• Bed rest
• Supine for 8 hours after spinal anesthetic
• Incentive Spirometry every 1 hour while awake
• Standard Diet
• Nothing by mouth for 8 hours after cesarean section
• Sips of water after 8 hour window
• Advance to clear liquids as tolerated
• Early Solid Diet Protocol
• Solid food within 8 hours of C-Section
• Well tolerated
• Resulted in faster bowel function return
• Shortened hospital stay by 24 hours

15. THE PATIENT CONTACTS YOU FOR:
• Contact physician for Temperature> 100.4
• Systolic Blood Pressure <90 mmHg or >140 mmHg
• Diastolic Blood Pressure>90 mmHg or <50 mmHg
• Heart Rate>130 or <60
• Respiratory Rate >32 or <8
• Urine output
• Foley Catheter in place: <60 cc in 2 hours
• Intermittent Urine collection: <300 cc per shift

16. THANK YOU
FOR BEARING!!!!