The document discusses the investigation and management of placenta previa, highlighting ultrasound as the primary method for placental localization. It details the conditions for vaginal or cesarean delivery, preventive guidelines, expectant and active management strategies, and associated complications for both the mother and fetus. Key management aims include ensuring maternal health while allowing for fetal maturity before delivery.

1. ANDINI SAHA
REG NO: 122016101082
PLACENTA PREVIA –
INVESTIGATION ,
MANAGEMENT AND
COMPLICATIONS

2. INVESTIGATION
ULTRASOUND
 IT IS THE MOST SIMPLE , PRECISE AND SAFE METHOD FOR PLACENTAL
LOCALISATION. A PARTIALLY FULL BLADDER IS NECESSARY TO IDENTIFY THE
LOWER EDGE OF THE PLACENTA . IF IT IS LESS THAN 3CM FROM THE MARGIN OF
THE INTERNAL OS, IT IS DIAGNOSED.
 THE POSTERIOR PLACENTA PREVIA IS DIFFICULT TO BE IDENTIFIED DUE TO
SHADOWING FROM THE PRESENTING PART OF FETUS . THIS CAN BE OVERCOME
BY HEAD DOWN TILT OF THE PATIENT OR DISPLACING THE PRESENTING PART
MANUALLY IF DIFFICULTY STILL PRESENT , THE DISTANCE BETWEEN THE
PRESENTING PART AND THE PROMONTORY OF THE SACRUM IS MEASURED. IF
THIS EXCEEDS 1.5 CM IT MEANS THAT PLACENTA LIES IN BETWEEN.

3.  IN MID – PREGNANCY THE PLACENTA REACHES THE INTERNAL OS IN UPTO 20%
OF PREGNANCIES .
 WITH INCREASING GESTATIONAL AGE AND THE FORMATION OF THE LOWER
UTERINE SEGMENT, A GAP DEVELOPS BETWEEN THE PLACENTAL EDGE AND THE
INTERNAL OS KNOWN AS PLACENTAL MIGRATION.
 COLOUR DOPPLER FLOW STUDY
 MRI
 VAGINAL EXAMINATION

4. MANAGEMENT
PREVENTION:
 TO MINIMIZE THE RISKS, THE FOLLOWING GUIDELINES ARE USEFUL:
 ADEQUATE ANTENATAL CARE
 SIGNIFICANCE OF WARNING HAEMORRHAGE.
AT HOME :
 PUT PATIENT ON BED
 ABDOMINAL EXAMINATION
 VAGINAL EXAMINATION MUST NOT BE DONE
TRANSFER TO HOSPITAL :
 ADMISSION TO HOSPITAL.

5. IMMEDIATE ATTENTION :
 TO ENSURE AN ADEQUATE BLOOD SUPLPLY TO A WOMAN AND FETUS PLACE
THE WOMAN IMMEDIATELY ON BED REST IN A SIDE LYING POSITION
 A LARGE BORE IV CANNULA IS CITED AND INFUSION OF NORMAL SALINE
 GENTLE ABDOMINAL PALPATION.

6.  VAGINAL DELIVERY IS ALLOWED IF THE FINDINGS ARE FULFILLED:
 PLACENTA PREVIA IS LATERALIS OR MARGINALIS ANTERIOR
 BLEEDING IS SLIGHT
 VERTEX PRESENTATION
 ADEQUATE PELVIS QITH SOFT TISSUE OBSTRUCTION
 PARTIALLY DILATED CERVIX TO ALLOW AMNIOTOMY

7. SCHEME OF MANAGEMENT
ALL APH PATIENTS ARE TO BE ADMITTED
EXPECTANT MANAGEMENT ACTIVE INTERFERENCE
• GENERAL AND ABDOMINAL EXAMINATION
• CLINICAL ASSESSMENT OF BLOOD LOSS
• RESUSCITATION IF NECESSARY
• LOCALISATION OF PLACENTA

8. EXPECTANT MANAGEMENT:
 THE EXPECTANT TREATMENT 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 HAEMODYNAMICALLY
 FETAL HEART SOUND GOOD
 CTG- REACTIVE FETUS.

9. INTERVENTIONS:
 BED REST
 PERIODIC INSPECTION OF VULVAL PAD
 SUPPLEMENTARY HAEMATINICS IF PATIENT IS ANAEMIC
 USE OF TOCOLYTICS
 Rh IMMUNOGLOBULINS TO ALL Rh NEGATIVE WOMEN.

10. ACTIVE MANAGEMENT
INDICATIONS :
 BLEEDING OCCURS AT OR AFTER 37 WEEKS OF PREGNANCY
 PATIENT IS IN LABOUR
 FETAL HEART SOUND IS ABSENT
 GROSS FETAL DEFORMATION
 DEAD FETUS.

11. ACTIVE MANAGEMENT CAN BE DIVIDED :
 VAGINAL DELIVERY
 CAESEREAN DELIVERY
 PLACENTAL EDGE IS WITHIN 2CM FROM THE INTERNAL OS: IN THIS CASE NO
INTERNAL EXAMINATION IS PERFORMRD AND CAESARIAN SECTION IS
CONSIDERED AS THE BEST CHOICE.

12. PLACENTAL EDGE IS 2-3 CM AWAY FROM INTERNAL CERVICAL OS:
INTERNAL
EXAMINATION IN
OT
ARM WITH OR
WITHOUT
OXYTOCIN
BLEEDING
CONTINUES AND
NO LABOUR
INITATION
CEASEAREAN
DELIVERY
SATISFACTORY
PROGRESS OF
LABOUR
VAGINAL DELIVERY

13. COMPLICATIONS
MATERNAL:
DURING PREGNANCY :
 ANTEPARTUM HAEMORRHAGE WITH VARYING DEGRE OF SHOCK
 MALPRESENTATION
 PREMATURE LABOUR
DURING LABOUR :
 EARLY RUPTURE OF MEMBRANE
 CORD PROLAOSE
 INTRAPARTUM HAEMMORHAGE

14.  POSTPARTUM HAEMORHAGE AND SHOCK
 RETAINED PLACENTA
FETAL COMPLICATION :
 LOW BIRTH WEIGHT
 ASPHYXIA
 INTRAUTERINE DEATH
 BIRTH INJURY