Placenta praevia

• Definition: The placenta embeds itself in the lower pole of

the uterus, partially or wholly covering the internal os in
front of the presenting part.
Risk factors
• --Prior placenta praevia
• --Large placental area (Multiple pregnancies…)
• --Advanced maternal age and High parity
• --Deficient endometrium (uterine scar, curettage, endome
tritis, fibroids…)
• --Uterine malformations
 Types
• Low lying,
• marginal,
• partial and
• complete placenta praevia
Signs and symptoms
• --Sudden onset of bright red fresh painless hemorrhage after 22 weeks of
gestation
• --Often malpresentation of the fetus
• --Endo-uterine cavity hemorrhage on speculum examination
 Complications
• --Hemorrhagic shock
• --Fetal distress
• --Anemia
• --Prematurity
• --Fetal death and/or maternal death
Investigations
• --Complete blood Count, blood group/Rhesus
• --Ultrasound
 Management
During pregnancy
• Bed rest
• Asymptomatic
• Follow up every 2 weeks

If complete placenta praevia

• Admit for fetal lung maturation ≥ 24 weeks of gestation
• Program a Cesarean section at 37-38 weeks of gestation
Symptomatic
• Obligatory admission, do FBC and Blood group crossmatch, blood
coagulation tests
• Surveillance of fetal heart rate
 Term >34 weeks of gestation
A) If minimal hemorrhage and no uterine contractions:
Expectant management
B) If Uterine contractions
• Complete placenta praevia or malpresentation: perfom
Cesarean section.
• Partial or marginal placenta preavia: Carefully perform
amniotom for vaginal delivery if the head is engaged.
 Term <34 weeks of gestation
A) If No Uterine contractions
• Fetal lung maturation with steroids (Dexamethasone 6 mg IM
every 12 hours for 48 hrs)
B) If Uterine contractions
• Tocolyse with Nifedipine short acting Tabs 20 mg start, then
continue with long acting nifedipine 20 mg every 8 hrs.
• If premature rupture of membrane: Ampicilline 2g start dose,
then Amoxycilline tabs 500mg TDS 5/7