This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant approach aims to continue the pregnancy for lung maturity using bed rest and monitoring. For abruption placentae, which is premature separation of a normally situated placenta, the active approach is indicated due to risks of further separation and fetal death, with immediate delivery by vaginal or cesarean delivery for severe cases.

1. NAVEENA.R.L’09.
Management of preterm labour in
Placenta previa and
Abruptio placentae
NAVEENA.R.L.
09

2. PLACENTA PREVIA
 It is a condition in which the placenta is located
over or very near the internal os.
 Four degrees:
Total placenta previa.
Partial placenta previa.
Marginal placenta previa.
Low lying placenta.

4. CLINICAL FEATURES
SYMPTOMS:
 Painless bleeding.
 Causeless bleeding.
 Recurrent bleeding.

5. SIGNS:
 Tachycardia or hypotension
 Anemia
 Uterus relaxed.Fetal parts easily felt.
-Vaginal examination must not be done.
DIAGNOSIS:
Transvaginal sonography.

6. Management of preterm labour in
placenta previa
 Diagnosis should be confirmed.
 Admit the patient.
 Management depends on,
 quantity of bleeding.
 overall physical condition of the mother.
 Overall fetus condition and fetal maturity.

7. Expectant line
of management
Active line of
management

8. Expectant line of management:
Macafee-Johnson’s regime
 Aim is to continue pregnancy for fetal lungs to
mature without compromising maternal health.
VITAL PREREQUISITES:
 Availability of blood transfusion.
 Facilities for caesarean section should be available
24 hrs.

9. Cases suitable for expectant
management:
 Mother is in good health: Hb>10 gm%;
haematocrit>30%.
 Duration of pregnancy <37 weeks.
 No active vaginal bleeding.
 Fetal wellbeing assured by USG.

10. Conduct of expectant treatment:
 Bed rest.
 Hb%, blood grouping, Urine protein.
 Fetal surveillance with USG.
 Blood transfusion to correct anemia.
 Tocolytics- Given if vaginal bleeding is associated with
uterine contractions.
 Corticosteroids to improve fetal lung maturity and
reduce respiratory distress.
 Rh immunoglobulin given to all Rh negative mothers.

11. Termination of expectant
treatment:
 It is carried upto 37 weeks of pregnancy and then
the baby becomes sufficiently mature after which
pregnancy is terminated.

12.  Preterm delivery may have to be done in
conditions such as,
 Recurrence of brisk haemorrhage which is continuing.
 Fetus is dead.
 Congenitally malformed fetus found on investigation.
However,there is a risk of IUGR with expectant
management.
When an early delivery is needed fetal
amniocentesis is done to find out whether the fetal
lungs are ready to breathe well.

13. Active line of management:
LOWER SEGMENT CAESAREAN DELIVERY- done for all
women with sonographic evidence of placenta previa
where placental edge is within 2 cm from internal os.
VAGINAL DELIVERY: when placenta edge is clearly 2-3 cm
away from internal os.

15. ABRUPTIO PLACENTAE
 It refers to a condition where antepartum heamorrhage
occurs due to premature seperation of a normally situated
placenta.
TYPES:
 Concealed: Blood is retained within the uterine cavity
and is not visible exernally.Retroplacental clot present.
 Revealed: In this the blood collected due to placental
seperation escapes by dissecting under the membranes
and seen externally if memabranes are ruptured.Blood
stained liquor may occur.
 Mixed

16. TYPES:

17. Clinical features:
 Abdominal pain and bleeding PV.
 Signs:
 Features of PIH.
 Shock.
 Uterine height may or may not correspond to the
period of amenorrhea.
 Uterine tenderness and difficulty in palpating fetal
parts in concealed variety.
 Fetal heart may be normal,abnormal or absent.
 Uterine contractions.

18.  Bleeding is almost always maternal.
Clinical Classification:
Grade 0- No clinical features,diagnosed after delivery
after seeing retroplacental clot.
Grade 1- Slight vaginal bleeding, Uterine tenderness
minimal or absent,BP and fibrinogen level
unaffected,FHS good.
Grade 3- Mild to moderate vaginal bleeding,uterine
tenderness,maternal pulse increased,BP
maintained,fibrinogen decreased,Fetal distress.
Grade 4-Severe bleeding,tender uterus,Fetal
death,Associated coagulation defect or anuria.

19.  COUVELAIRE UTERUS or uteroplacental apoplexy
includes severe forms of placental seperation with
widespread extravasation of blood into uterine
musculature.

20. Management:
Active line of
treatment

21.  ACTIVE MANAGEMENT is the main
mode of managing Abruptio placentae.
 In Expectant management:
Risk of sudden seperation of
placenta and fetal death.So it is not
done.

22. SEVERE CASES:
Immediate delivery of the fetus is indicated either
by vaginal delivery or ceasarean section.
 So, once abruption sets in,it is difficult to prevent
preterm labour.

23.  Vaginal delivery indicated when,
 Limited placental abruption.
 FHR is reassuring.
 Continuous electronic fetal monitoring available.
 Placental abruption with a dead fetus.
• If patient is not in labour and bleeding continues
deliver by,
 Induction of labour by low rupture of membranes.
 Caesarean section.

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