management of placenta previa


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management of placenta previa

  1. 1. NAVEENA.R.L’09. Management of preterm labour in Placenta previa and Abruptio placentae NAVEENA.R.L. 09
  2. 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.
  3. 3. CLINICAL FEATURES SYMPTOMS:  Painless bleeding.  Causeless bleeding.  Recurrent bleeding.
  4. 4. SIGNS:  Tachycardia or hypotension  Anemia  Uterus relaxed.Fetal parts easily felt. -Vaginal examination must not be done. DIAGNOSIS: Transvaginal sonography.
  5. 5. 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.
  6. 6. Expectant line of management Active line of management
  7. 7. 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.
  8. 8. 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.
  9. 9. 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.
  10. 10. Termination of expectant treatment:  It is carried upto 37 weeks of pregnancy and then the baby becomes sufficiently mature after which pregnancy is terminated.
  11. 11.  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.
  12. 12. 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.
  13. 13. 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
  14. 14. TYPES:
  15. 15. 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.
  16. 16.  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.
  17. 17.  COUVELAIRE UTERUS or uteroplacental apoplexy includes severe forms of placental seperation with widespread extravasation of blood into uterine musculature.
  18. 18. Management: Active line of treatment
  19. 19.  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.
  20. 20. 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.
  21. 21.  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.
  22. 22. THANK YOU!!!