Placenta praevia

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Placenta praevia
Classification and external resources

Diagram showing a Type IV placenta praevia.
ICD-10O44, P02.0
ICD-9641.0, 641.1
MedlinePlus000900
MeSHD010923
 
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Placenta praevia
Classification and external resources

Diagram showing a Type IV placenta praevia.
ICD-10O44, P02.0
ICD-9641.0, 641.1
MedlinePlus000900
MeSHD010923

Placenta praevia (placenta previa AE) is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix.[1] It can sometimes occur in the later part of the first trimester, but usually during the second or third. It is a leading cause of antepartum haemorrhage (vaginal bleeding). It affects approximately 0.5% of all labours.[2]

Placenta praevia is hypothesized[who?] to be related to abnormal vascularisation of the endometrium caused by scarring or atrophy from previous trauma, surgery, or infection.

In the last trimester of pregnancy the isthmus of the uterus unfolds and forms the lower segment. In a normal pregnancy the placenta does not overlie it, so there is no bleeding. If the placenta does overlie the lower segment, as is the case with placenta praevia, it may shear off and a small section may bleed.

Contents

Diagnosis

Women with placenta praevia often present with painless, bright red vaginal bleeding. This bleeding often starts mildly and may increase as the area of placental separation increases. Praevia should be suspected if there is bleeding after 24 weeks of gestation. Abdominal examination usually finds the uterus non-tender and relaxed. Leopold's Maneuvers may find the fetus in an oblique or breech position or lying transverse as a result of the abnormal position of the placenta. Praevia can be confirmed with an ultrasound.[3] In parts of the world where ultrasound is unavailable, it is not uncommon to confirm the diagnosis with an examination in the surgical theatre.

The proper timing of an examination in theatre is important. If the woman is not bleeding severely she can be managed non-operatively until the 36th week. By this time the baby's chance of survival is as good as at full term.

Placenta previa is classified according to the placement of the placenta:

Incidence

Placenta previa occurs approximately one of every 250 births. One third of all antepartum hemorrhage occurs due to placenta previa.[citation needed]

Risk factors

The following have been identified as risk factors[citation needed] for placenta praevia:

Placenta previa is itself a risk factor of placenta accreta.

Intervention

An initial assessment to determine the status of the mother and fetus is required. Although mothers used to be treated in the hospital from the first bleeding episode until birth, it is now considered safe to treat placenta praevia on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress. Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress. Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary.

There is debate as to whether vaginal delivery or delivery by Caesarean section is the safest method. In cases of fetal distress a Caesarean section is indicated. Caesarian section is contraindicated in cases of disseminated intravascular coagulation.

A problem exists in places where a Caesarean section cannot be performed, due to the lack of a surgeon or equipment. In these cases the infant can be delivered vaginally. There are two ways of doing this with a placenta praevia:

The goal of this type of delivery is to save the mother, and both methods will often kill the baby. These methods were used for many years before Caesarean section and saved the lives of both mothers and babies with this condition.[citation needed]

The main risk with a vaginal delivery with a praevia is that as you are trying to bring down the head or a leg, you might separate more of the placenta and increase the bleeding.

Placenta praevia increases the risk of puerperal sepsis and postpartum haemorrhage because the lower segment to which the placenta was attached contracts less well post-delivery.

References

  1. ^ [http://www.uabhealth.org/15407/[dead link] "www.uabhealth.org"]. University of Alabama at Birmingham. http://www.uabhealth.org/15407/[dead link]. Retrieved 2010-01-11. [dead link]
  2. ^ "Placenta Previa". http://pregnancy.emedtv.com/placenta-previa/placenta-previa.html. 
  3. ^ Bhide, Amar; Thilaganathan, Basky (2004). "Recent advances in the management of placenta previa". Current Opinion in Obstetrics and Gynecology 16 (6): 447–51. doi:10.1097/00001703-200412000-00002. PMID 15534438. 
  4. ^ Weerasekera, D. S. (2000). "Placenta praevia and scarred uterus - an obstetrician's dilemma". Journal of Obstetrics & Gynaecology 20 (5): 484–5. doi:10.1080/014436100434659. PMID 15512632. 
  5. ^ http://www.springerlink.com/content/166625291530lv57/?MUD=MP
  6. ^ http://www.patient.co.uk/doctor/Placenta-Praevia.htm[full citation needed]

External links