Antepartum haemorrhage Placenta

praevia

Antepartum Hemorrhage
Any bleeding occurring from the
genital tract during pregnancy after
24 weeks of POA but before birth of
the baby

Causes
Placenta previa
Placental Abruption
Vasa previa - unsupported umbilical vessels that lie
below the presenting part and run across the cervical os

Local Cervical Lesions

Polyps
Carcinoma
Show
Cervical ectropian

Placenta praevia
Definition:
Placenta that is implanted
completely or partially over the lower
uterine segment after 28 weeks of
POA

 Before 20 weeks gestation,4-6% have some degree

of low lying placenta on ultrasonic examination
90% of these resolve by the third trimester

Aetiology
Defective decidua basalis The placenta encroaches over a wide area in the uterine wall ( seen in older patients,
grand multipara, past history of manual removal of placenta, D & C or previous
caesarean section)

Hyperplacentosis:
larger area is covered by the placenta
e.g. Multiple pregnancy, Rh Isoimmunisation.

Association with placental and cord abnormalities :

Battledore placenta, membranous placenta, succenturiate lobe, velamentous cord insertion.

Smoking and drug abuse (cocaine)

increase the incidence of placenta previa.

PLACENTA PRAEVIA - DEGREES

Grade 1
The placenta is implanted in the lower uterine segment but
placental edge does not reach the internal os but is in close
proximity to it.

Grade 2
The edge of the placenta is at the margin of the internal os,but
does not cover it

Grade 3
The internal os is partially covered by placenta

Grade 4
The internal cervical os is covered completely by placenta.

Presentation
Painless vaginal bleeding (70%)
Spontaneous,
The most characteristic symptom
late pregnancy (after the 28th week)
Characteristics: sudden, painless and profuse
No symptoms
Routine ultrasound finding

Anemia or shock
repeated bleeding anemia
heavy bleeding shock

Abnormal fetal position

high presenting part
breech presentation

Complications
Severe haemorrhage
Recurrent bleeding ,leading to
admission
Increased fetal anomalies
Morbidly adherent placenta high
morbidity & mortality

Placenta accreta
Placenta increta
Placenta percreta

Management
All mothers with low lying placenta at
early pregnancy repeat USS at 32
weeks to confirm placental site
Delivery after 37 weeks
Major degree previa EL/LSCS
Minor degree if edge of the placenta > 2.5
cm away can try for vaginal delivery

If bleeding at < 37 weeks

Delivery if maternal or fetal compromise