(1) Placenta previa is when the placenta covers all or part of the internal cervical os, and can cause painless bleeding in the third trimester. (2) It is classified as central, partial, or marginal depending on how close it is to the cervical os. (3) Complications include bleeding during or after delivery, as well as preterm delivery. Placental abruption occurs when the placenta separates from the uterus prematurely. It can cause abdominal pain and vaginal bleeding. Complications include disseminated intravascular coagulation and postpartum hemorrhage. Treatment depends on gestational age and condition of the mother and fetus, with delivery often needed.

1. Placenta previaPlacenta previa
Placental abruption
Women’s Hospital School of MedicineWomen’s Hospital School of Medicine
Zhejiang UniversityZhejiang University
Wang ZhengpingWang Zhengping

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. Placenta previaPlacenta previa

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. 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. 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. (1) complete placenta previa
(2) partial placenta previa
(3) marginal placenta previa

8. Classification
Types of placenta previa.

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. • 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. Auxiliary examination
 B-ultrasound examination
 Placenta examination post partum
<7cm
 MRI

12. marginal placenta previa

13. partial placenta previa

14. central placenta previa

15. Differential diagnosis
• Placental abruption
• Disruption of vasa previa
• Cervical polyp or erosion
• Cancer of cervix

16. Complication of mother
and fetus
Bleeding at or post partum
 Implantation of placenta
 Anemia and puerperal infection
 Premature delivery

17. Implantation of placenta

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.  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

21.  Transport in emergency condition
In the neighborhood
Initiatory management

22. Placental abruption

23. 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‰

24. 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

25. 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

26. Uteroplacental apoplexy:
widespread extravasation of blood
into the uterine musculature and
beneath the uterine serosa

27. 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

28. Auxiliary examination
Diagnotic examination:
B-ultrasound examination
Placenta examination post partum
Blood Rt,Blood coagulation,blood
examination of hepatic and renal
function

29. Sonography

30. Differential diagnosis
• Placental previa
• Uterus rupture

31. Complications
DIC,dysfunction of coagulation
Post partum hemorrhagic/shock
Amniotic fluid embolism
Acute renal failure
Fetal death

32. 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

33. Management
Mature fetus Deliver
Compromised mother Deliver
Immature fetus
Expectant, if mother stable

34. Expectant Management
• Bed rest
• Ongoing maternal monitoring
• Fetal assessment: age, growth, well
being
• Deliver if recurrent signs / symptoms
• Deliver at fetal maturation

35. Severe placental
abruption:
• Resuscitation
• Evaluate and treat coagulation defect
• Deliver the fetus: Cesarean section
• Prevention of PPH
• Monitor renal status closely