PLACENTA PREVIA

Presented by: Group 1

DEFINITION

• the placenta is partially or

completely over the lower
uterine segment (over the
adjacent to the internl os)
it is called placenta previa
INCIDENCE

• in 80% cases it is found in multiparanouse

women
• the incidence is increased beyond the age
of 35, with high birth order pregnancies and
in multiple pregnancy.
• the incidence pproximtely 4-5 per thousands
pregnancies.
RISK FACTORS
• Multiparity
• incresed maternl age
• higher altitude
• history of previous scar in the uterus
• smoking
TYPES
• there are 4 types of placenta
previa depending upon the
degree of extension of
placenta to the lower segment

• TYPE 1 (low lying)

• TYPE 2 (MARGINAL)
• TYPE 3 (incomplete or partial
central)
• TYPE 4 (central or total)
TYPES / DEGREES OF PLACENTA PREVIA

• TYPE 1 ( LOW LYING)

- the major part of the
placenta is attached to the
upper segment and only the
lower margin enroaches
onto the lower segment but
not to the os.
TYPES / DEGREES OF PLACENTA PREVIA

• TYPE 2 (marginal)
- the placenta reaches the
margin of internal os but
does not cover it.
TYPES / DEGREES OF PLACENTA PREVIA

• TYPE 3 ( incomplete or
partial central)

- the placent covers the

internal os partially ( cover
the internal os when closed
but does not entirely do so
when fully dilated)
TYPES / DEGREES OF PLACENTA PREVIA

• TYPE 4 (central or total)

The placenta completely
covers the internal os even
efter it is fully dilated.
CLINICAL FEATURES

• SYMPTOMS:
Vaginal bleeding
• sudden in onset, pinless
• reveled bleeding (fresh blood)
• bright red or drk colored
• unrelted to ctivity
CONTN...
• SIGNS:
• general condition and anemia are proportionate to the visible
blood loss
ABDOMINAL EXAMINATION:
the size of the uterus
- the uterus feels relaxed and soft
- the head is floating in contrast to the period of gestation
- fetal heart sound is usually present
VAGINAL EXAMINATION:
- placenta is felt on the lower segment
COMPLICTIONS OF PLACENTA PREVIA
1. MATERNAL COMPLICATIONS
• During pregnancy
- Antepartum hemorrhage
- malpresentation
- premature labour
• During labor
- early rupture of the membrane
- cord prolapse
- slow dilation of cervix
- intrapartum hemorrhage
• Puerperium
- postpartum hemorrhage
- retained placenta
- subinvolution

FETAL COMPLICATIONS
- Low birth weight
- Asphyxia
- Intruterine death
DIAGNOSIS

• PLACENTOGRPHY
- sonography
- color doppler flow study
- magnetic resonance
- vginl examination
PREVENTION • IMMEDITE ATTENTION:
• to minimie the risk, the
• to ensure an adequate blood
following guidelines re
supply to women and fetus
useful
place the woman immeditely on
- adequate antenatal care bed rest in side lying position.
- significance of warning • large IV cannula is cited and
hemorrhage infusion of normal saline
• AT HOME • gentle abdominal palpation
- put the pt on bed
- abdominal examination
- vaginal examination must
not be done
SCHEME OF MANAGEMENT

• EXPECTANT MANAGEMENT
- the expectant treatment is carried upto 37 weeks.
AIM: the aim is to continue pegnncy for fetl mturity
without comprmisisng the mternl helth.
INDICATIONS:
- No active bleeding
- patient stble hemo-dynamiclaly
- FHS -good
- CTG -rective fetus
CONTD...

• INTERVENTION:
-bedrest
- periodic inspection of vulval pads
- supplementry hematinics if patient is anemic
- use of tocolytics
- RH immunoglobulins to all rh negative women
ACTIVE MANAGEMENT

• INDICATIONS
- bleeding occurs at or fter 37 weeks of pregnancy
- patient is in labor
- FHS - absent
- gross fetal maformation
- dead fetus
CONTD..

• ACTIVE MANAGEMENT

vaginal delivery caesrian delivery

placental edge is within 2 cm from the internal os: in this
case no internal exmination is performed and caesarian
section is considered as the best choice
THANK YOU!!