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    Placenta Previa Abruptio

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    rizkicky
    Placenta previa occurs when the placenta implants in the lower uterine segment over the internal cervical os. Risk factors include prior uterine surgery, multiparity, advanced maternal age, male fetus, smoking, and high altitude. Ultrasound is used to diagnose and monitor placenta previa. Management depends on gestational age and bleeding but may include bed rest, corticosteroids, and ultimately delivery by cesarean section. Placental abruption is the premature separation of the placenta from the uterus and can cause vaginal bleeding, uterine contractions, abdominal pain, and fetal distress. Risk factors include hypertension, trauma, smoking, thrombophilia, and prior abruption. Ultrasound and blood

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    Placenta Previa Abruptio

    Uploaded by

    rizkicky
    97 views44 pages
    Placenta previa occurs when the placenta implants in the lower uterine segment over the internal cervical os. Risk factors include prior uterine surgery, multiparity, advanced maternal age, male fetus, smoking, and high altitude. Ultrasound is used to diagnose and monitor placenta previa. Management depends on gestational age and bleeding but may include bed rest, corticosteroids, and ultimately delivery by cesarean section. Placental abruption is the premature separation of the placenta from the uterus and can cause vaginal bleeding, uterine contractions, abdominal pain, and fetal distress. Risk factors include hypertension, trauma, smoking, thrombophilia, and prior abruption. Ultrasound and blood

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    placenta previa

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    Placenta previa occurs when the placenta implants in the lower uterine segment over the internal cervical os. Risk factors include prior uterine surgery, multiparity, advanced maternal age, male fetus, smoking, and high altitude. Ultrasound is used to diagnose and monitor placenta previa. Management depends on gestational age and bleeding but may include bed rest, corticosteroids, and ultimately delivery by cesarean section. Placental abruption is the premature separation of the placenta from the uterus and can cause vaginal bleeding, uterine contractions, abdominal pain, and fetal distress. Risk factors include hypertension, trauma, smoking, thrombophilia, and prior abruption. Ultrasound and blood

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    97 views44 pages

    Placenta Previa Abruptio

    Uploaded by

    rizkicky
    Placenta previa occurs when the placenta implants in the lower uterine segment over the internal cervical os. Risk factors include prior uterine surgery, multiparity, advanced maternal age, male fetus, smoking, and high altitude. Ultrasound is used to diagnose and monitor placenta previa. Management depends on gestational age and bleeding but may include bed rest, corticosteroids, and ultimately delivery by cesarean section. Placental abruption is the premature separation of the placenta from the uterus and can cause vaginal bleeding, uterine contractions, abdominal pain, and fetal distress. Risk factors include hypertension, trauma, smoking, thrombophilia, and prior abruption. Ultrasound and blood

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 44

    Placenta Previa

    Hai Ho, MD
    Department of Family Practice

    What is placenta previa?

    Implantation of placenta over cervical os

    Types of placenta previa

    Who are at risk for placenta previa?


    Endometrial scarring of upper segment of

    uterus implantation in lower uterine


    segment
    Prior D&C or C-section
    Multiparity
    Advance age independent risk factor vs.
    multiparity

    Who are at risk for placenta previa?


    Reduction in uteroplacental oxygen or

    nutrient delivery compensation by


    increasing placental surface area
    Male
    High altitude
    Maternal smoking

    Factors that determine persistence of


    placenta previa?
    Time of diagnosis or onset of symptoms
    Location of placenta previa

    Repeat ultrasound at 24 28
    weeks gestation

    Clinical presentations?
    Painless vaginal bleeding 70-80%

    1/3 prior to 30 weeks


    Mostly during third trimester shearing force
    from lower uterine segment growth and
    cervical dilation
    Sexual intercourse

    Uterine contraction 10-20%

    Fetal complications?
    Malpresentation
    Preterm premature rupture of membrane

    Diagnostic test?

    Ultrasound

    Placenta Previa: ultrasound

    Placenta

    Placenta Previa: ultrasound

    Placenta accreta?
    Abnormal attachment of the placenta to the

    uterine wall (decidua) such that the chorionic


    villi invade abnormally into the myometrium
    Primary deficiency of or secondary loss of
    decidual elements (decidua basalis)
    Associated with placenta previa in 5-10% of
    the case
    Proportional to the number of prior Cesarean
    sections

    Variations of placenta accreta

    Placenta accreta: ultrasound

    Vasa Previa?

    Vasa Previa

    on
    i
    t
    r
    se
    n
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    ous
    t
    n
    me
    a
    l
    Ve

    Vasa Previa

    Velam
    entou
    s inse
    rtion

    Vasa Previa
    m
    la
    Ve

    us
    to
    en

    on
    rt i
    se
    in

    Vasa Previa
    Rupture
    Compression of vessels
    Perinatal mortality rate

    50 75%

    Management of placenta previa?


    Individualized based on (not much evidence):
    Gestational age
    Amount of bleeding
    Fetal condition and presentation

    Preterm with minimal or resolved


    bleeding
    Expectant management bed rest with

    bathroom privilege
    Periodic maternal hematocrit
    Prophylactic transfusion to maintain
    hematocrit > 30% only with continuous lowgrade bleeding with falling hematocrit
    unresponsive to iron therapy

    Preterm with minimal or resolved


    bleeding
    Fetal heart rate monitoring only with active

    bleeding
    Ultrasound every 3 weeks fetal growth, AFI,
    placenta location
    Rhogam for RhD-negative mother

    Preterm with minimal or resolved


    bleeding
    Amniocentesis weekly starting at 36 weeks to

    assess lung maturity delivered when lungs


    reach maturity
    Betamethasone or dexamethasone between
    24 34 weeks gestation to enhance lung
    maturity
    Tocolysis magnesium sulfate

    Active bleeding
    Stabilize mother hemodynamically
    Deliver by Cesarean section
    Rhogam in Rh-negative mother
    Betamethasone or dexamethasone between

    24 34 weeks gestation to enhance lung


    maturity

    Management of placenta previa


    No large clinical trials for the

    recommendations
    Consider hospitalization in third-trimester
    Antepartum fetal surveillance
    Corticosteroid for lung maturity
    Delivery at 36-37 weeks gestation

    Management of placenta accreta


    Cesarean hysterectomy
    Uterine conservation

    Placental removal and oversewing uterine


    defect
    Localized resection and uterine repair
    Leaving the placenta in situ and treat with
    antibiotics and removing it later

    Placenta Abruption

    What is placental
    abruption?
    Premature separation of placenta from the
    uterus

    Epidemiology
    Incident 1 in 86 to 1 in 206 births
    One-third of all antepartum bleeding

    Pathogenesis
    Maternal vascular disruption in decidua

    basalis
    Acute versus chronic

    Types of placental abruption


    16%

    81%

    4%

    Types of placenta hemorrhage

    Risk factors for placental abruption?


    Maternal hypertension
    Maternal age and parity conflicting data
    Blunt trauma motor vehicle accident and

    maternal battering
    Tobacco smoking and cocaine

    Risk factors for placental abruption


    Prior history of placental abruption

    5-15% recurrence
    After 2 consecutive abruptions, 25%
    recurrence

    Sudden decompression of uterus in

    polyhydramnios or multiple gestation (after


    first twin delivery) rare
    Thrombophilia such as factor V Leiden
    mutation

    Clinical presentations?
    Vaginal bleeding
    Uterine contraction or tetany and pain
    Abdominal pain
    DIC

    10-20% of placental abruption


    Associated with fetal demise

    Fetal compromise

    Diagnostic test?
    Ultrasound

    Sensitivity ~ 50%
    Miss in acute phase because blood could be
    isoechoic compared to placenta
    Hematoma resolution hypoechoic in 1 week
    and sonolucent in 2 weeks

    Blood tests

    Ultrasound: subchorionic abruption

    Ultrasound: retroplacental abruption

    Ultrasound: retroplacental abruption

    Blood tests?
    CBC hemoglobin and platelets
    Fibrinogen

    Normal 450 mg/dL


    <150 mg/dL severe DIC

    Fibrin degradation products


    PT and PTT

    Management?
    Hemodynamic monitoring

    Urine output with Foley


    BP drop late stage, 2-3 liter of blood loss

    Fetal monitoring

    Management: delivery
    Timing

    Severity of placental abruption


    Fetal maturity - consider tocolysis with MgSO4
    and corticosteroid (24-34 weeks)
    Correction of DIC with transfusion of PRBC,
    FFP, platelets to maintain hematocrit > 25%,
    fibrinogen >150-200 mg/dL, and platelets >
    60,000/m3

    Mode: vaginal vs. Cesarean-section

    Couvelaire uterus?
    Bleeding into myometrium leading to uterine

    atony and hemorrhage


    Treatment
    Most respond to oxytocin and methergine
    Hysterectomy for uncontrolled bleeding

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