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BY Zahidah bt Zakaria 030.07.

346 Kepaniteraan Ilmu Kandungan dan Kebidanan RSAL Fakultas Kedokteran Trisakti

Definition of placenta previa

Describe a placenta that is implanted over or very near the internal cervical os

Prior caesarean delivery Multiparity

Smoked cigarettes

Maternal age

Risk Factor

Maternal serum alpha feto protein

Painless bleeding in 2nd trimester and early 3rd trimester

Development of LUS and effacement of cervix

Intercourse and Vaginal examination

Transabdominal US

Transvaginal US

Transperineal US

MRI

Conservative mx Prolongation of pregnancy by 4 wk after initial bleeding. Bethamehasone to pts < 34 wk gestation. Tocolytics prolongation of pregnancy Hospitalization until free from bleeding for 48H Outpatients management

Delivery Definite PP at 36 wk Excessive bleeding Concern about fetal condition. >2cm from cervix : Vaginal delivery <2cm from cervix : Caesarean delivery

Hospitalization - IV cannula FBC/Type/Screening Bleeding Sonographic examination -Tocolytic -Steroid

-Blood transfusion
-Discharge after free from bleeding for 48 H Access to telephone Outpatient Responsible adult

Transportation available
Reasonable distance

Post partum hemorrhage (PPH) account for 140,000 death/year or maternal death every 4 min. Significant contributor = abnormal placentation + caesarean delivery. Profuse bleeding from LUS due to removal of placenta previa/ accreta is a challenging problem. Management : Conservative Uterotonic Uterine packing Oversewing

Overdistended uterus High Parity

Uterine Atony

PPH

Prior PPH

Conservative measure
Uterotonics Intrauterine ballon tamponade

Invasive Intervation
Ligation of uterine and hypogastric a.

Uterine Packing

Oversewing
Hysterectomy

Hysterotomy Incision

Plastic glove tied at distal end of catheter

500ml NS bag tide at distal end of catheter as traction

24 F foley catheter inserted, distal end pass tru cervix and pull tru vagina

Hysterotomy incision closed

Postop : Oxytocin infuse for 12 H. 800mcg misoprostol rectally and 3 dose of cefazolin

Infused ballon et 60100ml NS and traction applied

Haemostasis achieved

Ballon left in situ for 1824 hr

Discussion
Uteroronics/ Uterine Massage
LUS doesnt respond due to poor contractile nature

Oversewing Tamponade
Emergency hysterectomy

Slow down the bleeding but not completly . Potential risk : injury to bladder, ureter and vasculare structure Uterine pack/ IU ballons IU pack was abandoned due to concealed hemorrhage, infection and trauma

Used for placental abnormalities