Placenta previa

Июль 25, 2022

Содержание

2. General considerations Definition In placenta previa, the placenta is implanted in the lower uterine segment and
4. Etiology Uncertain High risk factors maternal age: >35 years multiparity: 85% - 90% prior cesarean delivery:
5. Etiology Causes Endometrial abnormality Scared or poorly vascularized endometrium in the corpus. Curettage, Delivery, CS and
6. Classification Total placenta previa The internal cervical os is covered completely by placenta Partial placenta previa
7. classification
8. Manifestation Painless hemorrhage The most characteristic symptom Time: late pregnancy (after the 28th week) and delivery
9. Manifestation Anemia or shock repeated bleeding→ anemia heavy bleeding→ shock Abnormal fetal position a high presenting
10. Diagnosis History Painless hemorrhage At late pregnancy or delivery History of curettage or CS
11. Diagnosis Signs Abdominal findings Uterus is soft, relaxed and nontender. Contraction may be palpated. A high
12. Diagnosis Speculum examination (窥阴检查) Rule out local causes of bleeding, such as cervical erosion or polyp
13. Diagnosis Ultrasonography The most useful diagnostic method: 95% Not make the diagnosis at the mid pregnancy.
14. Differential Diagnosis Placental abruption vagina bleeding with pain, tenderness of uterus. Vascular previa Abnormality of cervix
15. Effects obstetrical hemorrhage Placenta accreta Anemia and infection Premature labor or fetal death or fetal distress
16. Treatments Expectant therapy Rest: keep the bed Controlling the contraction: MgSO4 Treatment of anemia Preventing infection
17. Treatments Termination of pregnancy CS total placenta previa (36th week), Partial placenta previa (37th week) and
18. Treatments Vaginal delivery Marginal placenta previa Vaginal bleeding is limited
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General considerations
Definition
In placenta previa, the placenta is implanted in the

lower uterine segment and located over the internal os. It constitutes an obstruction of descent of the presenting part.
Main cause of obstetrical hemorrhage
Incidence
0.24%-1.57% (our country).

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Etiology
Uncertain
High risk factors
maternal age: >35 years
multiparity: 85% - 90%
prior cesarean delivery:

5 times
smoking

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Etiology
Causes
Endometrial abnormality
Scared or poorly vascularized endometrium in the corpus.
Curettage, Delivery, CS

and infection of endometrium
Placental abnormality
Large placenta (multiple pregnancy), succenturiate lobe (副胎盘)
Delayed development of trophoblast

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Classification
Total placenta previa
The internal cervical os is covered completely by placenta
Partial

placenta previa
The internal os is partially covered by placenta
Marginal placenta previa
The edge of the placenta is at the margin of the intenal os.

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classification

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Manifestation
Painless hemorrhage
The most characteristic symptom
Time: late pregnancy (after the 28th

week) and delivery
Characteristics: sudden, painless and profuse
Cause of bleeding
Mechanical separation of the placenta from its implantation site, either during the formation of the lower uterine segment, during effacement and dilatation of the cervix in labor. Placentitis. Rupture of the venous in the decidua basalis

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Manifestation
Anemia or shock
repeated bleeding→ anemia
heavy bleeding→ shock
Abnormal fetal position

a high presenting part
breech presentation (often)

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Diagnosis
History
Painless hemorrhage
At late pregnancy or delivery
History of curettage or CS

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Diagnosis
Signs
Abdominal findings
Uterus is soft, relaxed and nontender.
Contraction may be palpated.
A

high presenting part can’t be pressed into the pelvic inlet. Breech presentation
Fetal heart tones maybe disappear (shock or abruption)

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Diagnosis
Speculum examination (窥阴检查)
Rule out local causes of bleeding, such as

cervical erosion or polyp or cancer.
Limited vaginal examination (seldom used)
Palpation of the vaginal fornices to learn if there is an intervening bogginess between the fornix and presenting part.
Rectal examination is useless and dangerous

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Diagnosis
Ultrasonography
The most useful diagnostic method: 95%
Not make the diagnosis at the

mid pregnancy. (≥34 weeks)
MRI
Check the placenta and membrane after delivery

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Differential Diagnosis
Placental abruption
vagina bleeding with pain, tenderness of uterus.
Vascular

previa
Abnormality of cervix
cervical erosion or polyp or cancer

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Effects
obstetrical hemorrhage
Placenta accreta
Anemia and infection
Premature labor or fetal death or fetal

distress

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Treatments
Expectant therapy
Rest: keep the bed
Controlling the contraction: MgSO4
Treatment of anemia
Preventing

infection

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Treatments
Termination of pregnancy
CS
total placenta previa (36th week), Partial placenta previa (37th

week) and heavy bleeding with shock
Preventing postpartum hemorrhage: pitocin and PG
Hysterectomy: Placenta accreta or uncontroled bleeding

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Placenta previa

Содержание

General considerationsDefinition In placenta previa, the placenta is implanted in the

EtiologyUncertainHigh risk factorsmaternal age: >35 yearsmultiparity: 85% - 90%prior cesarean delivery:

EtiologyCausesEndometrial abnormalityScared or poorly vascularized endometrium in the corpus.Curettage, Delivery, CS

ClassificationTotal placenta previaThe internal cervical os is covered completely by placentaPartial

classification

Manifestation Painless hemorrhageThe most characteristic symptomTime: late pregnancy (after the 28th

ManifestationAnemia or shock repeated bleeding→ anemia heavy bleeding→ shockAbnormal fetal position

DiagnosisHistoryPainless hemorrhageAt late pregnancy or deliveryHistory of curettage or CS

DiagnosisSignsAbdominal findingsUterus is soft, relaxed and nontender. Contraction may be palpated.A

DiagnosisSpeculum examination (窥阴检查) Rule out local causes of bleeding, such as

DiagnosisUltrasonographyThe most useful diagnostic method: 95%Not make the diagnosis at the

Differential DiagnosisPlacental abruption vagina bleeding with pain, tenderness of uterus. Vascular

Effectsobstetrical hemorrhagePlacenta accretaAnemia and infectionPremature labor or fetal death or fetal

Treatments Expectant therapyRest: keep the bedControlling the contraction: MgSO4Treatment of anemiaPreventing

TreatmentsTermination of pregnancyCStotal placenta previa (36th week), Partial placenta previa (37th

TreatmentsVaginal delivery Marginal placenta previa Vaginal bleeding is limited

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