Placenta previa occurs when the placenta is located low in the uterus, covering or near the cervical opening. There are four degrees of placenta previa based on how much of the cervical os is covered. Risk factors include cesarean delivery, uterine surgery, multiple gestations, advanced maternal age, and multiple pregnancies. Symptoms include painless third trimester bleeding. Placental abruption occurs when the placenta separates from the uterine wall before delivery and can cause bleeding, back pain, and contractions. Risk factors include hypertension, cocaine use, smoking, and prior abruption. Management depends on gestational age and degree of maternal and fetal compromise.

1. PLACENTA PREVIA
DEFINITION
IN PLACENTA PREIVA , THE PLACENTA IS LOCATED OVER
OR VERY NEAR THE INTERNAL OS. FOUR DEGREES OF THE
ABNORMALITY HAVE BEEN RECOGNIZED:
1. TOTAL PALCENTA PREIVA. THE INTERNAL CERVICAL OS
IS COVERED COMPLETELY BY PLACENTA
2. PARTIAL PLACENTA PREVIA. THE INTERNAL OS IS
PARTIALLY COVERED BY PLACENTA
3. MARGINAL PLACENTA PREVIA . THE EDGE OF THE
PLACENTA IS AT THE MARGIN OF THE INTERNAL OS.
4. LOW -LYING PLACENTA. THE PLACENTA IS IMPLANTED
IN THE LOWER UTERINE SEGMENT SUCH THAT THE
PLACENTAL EDGE ACTUALLY DOES NOT REACH THE
INTERNAL OS BUT IS IN CLOSE PROXIMITY TO IT .

2. PLACENTAL PRESENTATION
• When the placenta lies directly over the
internal os
• The estimated incidence of placenta
praevia at term is 0.5%
• Determining placental location by
ultrasound examination–18-22 weeks of
gestation

3. RISK FACTORS OF PLACENTAL PRESENTATION
• Cesarean birth
• Surgery on the uterus
• Twins or triplets
• Over the age of 35
• More than four pregnancies

4. SYMPTOMS OF PLACENTAL PRESENTATION
• Painless bleeding during the third trimester
• Premature contractions
• Baby is breech, or in transverse position
• Uterus measures larger than it should according to gestational age

5. PLACENTAL ABRUPTION
THE SEPARATION OF THE PLACENTA FROM ITS
SITE OF IMPLANTATION BEFORE THE DELIVERY
OF THE FETUS HAS BEEN VARIOUSLY CALLED
PLACENTAL ABRUPTION , ABRUPTION
PLACENTAE, ACCIDENTAL HEMORRHAGE AND
PREMATURE SEPARATION OF THE NORMALLY
IMPLANTED PLACENTA .

6. ETIOLOGY.
IT IS MORE COMMON:
-AFRICAN -AMERICAN WOMEN THAN WHITE OR LATIN-
AMERICAN WOMEN .
-PREGNANCY-INDUCED OR CHRONIC HYPERTENSION.
-PRETERM PREMATURELY RUPTURED MEMBRANES HAVE
HAVE BEEN ASSOCIATED WITH AN INCREASED
INCIDENCE OF PREMATURE PLACENTAL SEPARATION.
-EXTERNAL TRAUMA COULD BE IMPLICATED ONLY IN 3
OF 207 CASES OF SEVERE PLACENTAL ABRUPTION . -
COCAINE ABUSE
-UTERINE LEIOMYOMA, ESPECIALLY IF LOCATED BEHIND
THE PLACENTAL IMPLANTATION

7. CLINICAL DIAGNOSIS
IT IS EMPHASIZED THAT THE SIGNS AND SYMPTOMS WITH
ABRUPTION PLACENTAE CAN VARY CONSIDERABLY.
IN 22 % OF CASES IDIOPATHIC PRETERM LABOR WAS
CONSIDERED TO BE THE DIAGNOSIS UNTIL SUBSEQUENT
FETAL DISTRESS - INCLUDING FETAL DEATH , SERIOUS
BLEEDING, BACK PAIN, UTERINE TENDERNESS , RAPID
UTERINE CONTRACTIONS OR PERSISTENT UTERINE
HYPERTONUS- WERE DETECTED SINGLY OR MORE OFTEN
IN COMBINATION. IMPORTANTLY , NEGATIVE FINDINGS
WITH ULTRASOUND EXAMINATION DO NOT EXCLUDE
LIFE-THREATENING PLACENTAL ABRUPTION

8. • Uteroplacental Apoplexy (Couvelaire Uterus). In the more sever forms of
placental abruption , widespread extravasation of blood into the uterine
musculature and beneath the uterine serosa is found. This phenomenon of
uteroplacental apoplexy that is frequently called Couvelaire uterus . Such
effusions of blood are also occasionally seen beneath the tubal serosa , in the
substance of the ovaries , as well as free in the peritoneal cavity .

9. PLACENTA ACCRETA
• When the placenta (or part of the placenta) invades and is inseparable from the
uterine wall
• Placenta accreta can cause bleeding during the third trimester and severe blood loss
during delivery
• Most cases can be found during pregnancy with a routine ultrasound exam
• Sometimes, it is not discovered until the baby is born
• Hysterectomy often needs to be done right after delivery to prevent life-threatening
blood loss

10. PLACENTA

11. TEAR OFF OF A NORMALLY ATTACHED PLACENTA
• Placental abruption is defined as premature separation of a normally implanted
placenta
• The risk to the fetus depends on both the severity of the abruption and the gestational
age at which the abruption occurs
• The danger to the mother is posed primarily by the severity of the abruption

12. RISK FACTORS
• Placental abruption in a previous pregnancy, unless the abruption was caused by abdominal trauma, assuming the trauma isn't
repeated in the current pregnancy
• Chronic high blood pressure (hypertension)
• High blood pressure during pregnancy, resulting in preeclampsia or eclampsia
• A fall or other type of blow to the abdomen
• Smoking
• Cocaine use during pregnancy
• Early rupture of membranes, which causes leaking amniotic fluid before the end of pregnancy
• Infection inside of the uterus during pregnancy (chorioamnionitis)
• Carrying more than one baby
• Being older, especially after age 40

13. SYMPTOMS OF PLACENTAL ABRUPTION
• Vaginal bleeding and abdominal pain
• The amount of vaginal bleeding correlates poorly with the degree of abruption
• Stillbirth occurring in most cases in which there is greater than 50% placental
separation
• The uterus is frequently tender and may feel hard on palpation
• Backache may be the only symptom, especially when the placental location is
posterior

14. MANAGEMENT
The management of placental abruption depends on:
• the presentation
• the gestational age
• the degree of maternal and fetal compromise