REFLEKSI KASUS

PLACENTA PRAEVIA
Pembimbing: Dr. dr. Cahyono Hadi, SH, Sp.OG(K)
Oleh: Widya Oktaviana Tarigan (406162013)
Kepaniteraan Klinik Ilmu Obstetri & Ginekologi
RSUD RAA Soewondo Pati, Jawa Tengah
 Patient
S O
Keluhan utama: terasa kencang & Compos mentis
ingin mengejan TTV: TD 110/60 mmHg
Riwayat perdarahan pada usia
HR 96 bpm
kehamilan 28 minggu & di diagnosis
plasenta previa totalis RR 18 bpm
Dirujuk dari puskesmas karena T 36.7*C
plasenta letak rendah
Wanita usia 29 tahun: G2P1A0
I: Laki-laki, 8 tahun, SC, RS
II: Hamil ini
HPHT: 1 September 2016
HPL: 8 Juni 2017
UK: 40 minggu
HT (-), DM (-), asma (-), alergi (-),
jamu (-), pijet (-), KB (+)
ANC: teratur, tiap bulan
 What is placenta praevia?

Latin previa means going before

Placenta previa: the placenta goes before the
fetus into the birth canal

Williams Obstetrics 24th edition

"A low-lying placenta (placenta previa) after 20 weeks". Royal College of Obstetricians & Gynaecologists.
Published on January 2010
 How often placenta praevia occurs?

North America: 2.9/1000 pregnancies

Global: 5.2/1000 pregnancies
Asia: 12.2/1000 pregnancies
1 SC = 4.5x risk for placenta praevia
21% of women admitted from 22 to 28 weeks
gestation with vaginal bleeding

Rowe T. Placenta Previa. Journal of Obstetric and Gynaecology Canada. 2014;36(8):667-668

 Who's at risk?

Maternal age
Multiparity
Prior SC delivery
History of placenta praevia
Cigarette smoking
Elevated perinatal screening MSAFP levels
Asian women >>

Williams Obstetrics 24th edition

Rowe T. Placenta Previa. Journal of Obstetric and Gynaecology Canada. 2014;36(8):667-668
 How does it happens?

1. Cannot be pricisely defined

2. Differential growth of the upper & lower uterine
segments

Williams Obstetrics 24th edition

Rowe T. Placenta Previa. Journal of Obstetric and Gynaecology Canada. 2014;36(8):667-668
 Classification
Placenta praevia -
internal os is covered
partially or completely by
placenta
In the past total or
partial praevia

Low lying placenta -

placental edge does not
reach the internal os
Previously used terms
marginal praevia

Williams Obstetrics 24th edition

Types of placenta praevia
 How is placenta praevia diagnosed?

Suspected at GA > 20 weeks with painless bleeding:

sentinal bleed
CE: double set-up technique rarely necessary
=finger be passed through the cervix and the placenta
palpated
*Digital examination should not be performed
Sonographical finding
MRI

"A low-lying placenta (placenta previa) after 20 weeks". Royal College of Obstetricians
& Gynaecologists. Published on January 2010
 USG

Williams Obstetrics 24th edition

 Management of placenta praevia
Depending individual cirumstances
3 factors maturity; labor; bleeding and its severity
Preterm fetus, no persistent active bleeding close observation
spontaneous delivery may be awaited
Near term, not bleeding scheduled SC delivery
Mostly SC
Previous guidelines: 34 weeks of GA hospitalized?
Dangerous haemorrhage, SC facilities not available control the
bleeding by pressure of the presenting part on the placenta
Head presentation: Willett's forceps applied to the fetal scalp &
traction maintained
Breech presentation: bring down a leg if at least two fingers can be
passed through the cervix
Extra antenatal care

Williams Obstetrics 24th edition

Rowe T. Placenta Previa. Journal of Obstetric and Gynaecology Canada. 2014;36(8):667-668
Royal College of Obstetricians & Gynaecologists. Published on January 2010
Obstetric Illustrated
 Let's reflect on our patient's case

29 yo woman with GA 40 weeks

Presents with minimal pain of antepartum haemorrhage
History of SC
History of antepartum haemorrage at GA 28 weeks & Dx with
placenta praevia totalis

DD: Placenta praevia totalis

Placenta praevia partialis
Plasenta praevia marginalis
Low lying placenta

USG placenta praevia totalis

SC delivery planning