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DR. ITSURA M P
OBS/GYNAECOLOGY
OUTLINE
Case description
Introduction and definition
Incidence, pathogenesis and risk factors
Clinical features
Diagnosis
Management
Summary
CASE
Para 4+1 G 6
Presented at 31 weeks with PV bleeding.
Previous obstetric performance
2 previous scars
2 SVD deliveries
All alive and well
INTRODUCTION
Placenta configuration/classification
I) Complete previa
Internal os is equidistant from anterior
and posterior edges.
Also classified as TYPE IV
Account for approximately 2030% of all
placenta previa.
classification
Incidence
Risk factors
Endometrial scarring
smoking
high altitude
Clinical manifestation
I) Painless vaginal bleeding after 20 weeks
70-80 %
2) Uterine contraction - 10-20% associated
with bleeding
3) Asymptomatic detected by ultra sound
< 10%
Bleeding
1/3 initial bleeding in < 30 weeks
associated with transfusion , pre-term
delivery and high perinatal mortality
1/3 bleed between 30-36 weeks
1/3 bleed after 36 weeks
10% reach term without bleeding
Bleeding more in third trimester
Bleeding mechanism
Associated conditions
Associated factors ct
Diagnosis
Differential diagnosis
Ultra sound
Transabdominal
-over distended bladder
-posterior previa in cephalic presentation
can be missed
Transvaginal relationship of placenta to
cervical os.
Translabial/ transperineal
Repeat ultrasound 28-32 weeks
M. R. I
Asymptomatic PP>20wks
Delivery
Caeserian section and or vaginal delivery
depending on type and condition of mother.
Anaesthesia
-general anaesthesia when
haemodynamicaly unstable
-regional when stable
Conservative management
When no significant (<500mls) bleed
prolongation lasted < 17 days.
Hospitalization versus outpatient
case base analysis.
-patient return to hospital quickly
-adult companion 24hours
-reliable and able to maintain bed rest
understand the risk
Conservative mnx ct
Delivery
Timing -Amniocentesis at 36, 37 weeks
-delivery by 38 weeks.
Route of delivery
-complete previa caesarian section
-low lying placenta role of SVD when edge >2cm
from OS
Double set up.
Marginal previa _ Risk of emergency delivery hence
elective caesarian section preferable.
procedure
2 4 units of blood
Be ready for emergency caesarian
hysterectomy.
Avoid placenta on entry to uterus.
Fast and skill in delivery helps
outcome
Summary
Summary
Thank you.