Download Placenta previa

Placenta previa
Placental abruption
Women’s Hospital School of Medicine
Zhejiang University
Wang Zhengping
Antepartum Hemorrhage
• Third-trimester bleeding
Obstetric: Placental separation
 Placental Previa
 Placenta Abruption
 Uterine Rupture
 vasa previa : Fetal Vessel Rupture
No obstetric: Acute vaginitis/cervicitis,
Cervical polyp, Cervical cancer, Trauma
Placenta previa
Definition
• Placenta previa:
The inferior edge of placenta load at
the lower uterine segment, or even reach
the internal cervical os after 28 weeks
gestation.
• Incidence rate:
Internal：0.24%~1.57%；
International：0.5%~0.9%。
Etiology
• High-risk group
Age of gravida>35
 Multipara
 Pregnancy women used to tobacco or dope

• Initial etiologic agnet
 Damage of endometria
 Development of the trophoblastic layer of
fertilized ovum delayed
 Anomaly of placenta
 Cicatricial uterus due to cesarean section ,e.g.
Classification
 Classified according to the relationship
between the edge of placenta and the
internal cervical os :
complete ( central ) placenta previa
partial placenta previa
marginal placenta previa
 Time to determine classification : the last
examination before managed
(1) complete placenta previa
(2) partial placenta previa
(3) marginal placenta previa
Classification
Types of placenta previa.
Clinical Features
 Painless 、recurrent vaginal bleeding in
the second or third trimester of
pregnancy
 Anemia,shock or even death corresponded
to the volume of vaginal bleeding
 The uterus is usually soft and relaxed
 Anomaly of fetal condition
 Per vagina examination
• Total
placenta
Centralprevia
placenta previa Partial
Partial placenta
placenta
previa
Early(20-28wks)
previa
•Large
Early(20amount
28wks)
Several
times
Between total and
Between
marginal total
• Large
and marginal
amount
• Several
times
Bleeding time and volume
Marginal placenta
previa
Marginal placenta
previa
Late(37-40WKS
or in labor )
Less
Late(37-40WKS
bleeding or
in labor )
Less bleeding
Auxiliary examination
 B-ultrasound examination
 Placenta examination post partum
<7cm
 MRI
marginal placenta previa
partial placenta previa
central placenta previa
Differential diagnosis
•
•
•
•
Placental abruption
Disruption of vasa previa
Cervical polyp or erosion
Cancer of cervix
Complication of mother
and fetus
Bleeding at or post partum
 Implantation of placenta
 Anemia and puerperal infection
 Premature delivery
Implantation of placenta
Management
 expectant treatment
 Indication: Fewer vaginal bleeding
Patient’s condition stabilization
<36 weeks gestation,
fetal weight<2300g
 Management: Lying in bed to take a rest
Inhibition of uterine contraction
Treatment aim at symptoms
Promote development of fetus
Prevention of infection
 Termination of pregnancy
Indication: 1.Severe vaginal bleeding
2.Gestation age >36 weeks, or fetal
lung function been matured
Mode of labor:According to the type of placenta
previa,volume of vaginal bleeding
and condition of gravia, et al.
Cesarean delivery is necessary in practically all women
with placental previa
 Transport in emergency condition
In the neighborhood
Initiatory management
Placental abruption
Definition
Placental abruption: placenta in normal site
strip from the uterine parietal partially
or completely before the fetus
expulsion,after 20 weeks gestation or in
the delivery procedure.
Incidence rate: 0.46%~2.1%
Neonatal mortality: 200‰~428‰
Etiology
 Angiopathy of vasa basalis
 Mechanical agent
 Venous pressure of uterus elevated abruptly
 Volume of uterus deflated abruptly
 Others: Age of gravida>35,multipara,
tobacco,dope
Classification
 Classify according to vaginal bleeding or nor:
Dominant/Recessive/Mixed
 Classify according to severity degree:
Light type ＜1/3
Severe type ＞1/3; ＞ 1/2, Dead fetus
Uteroplacental apoplexy:
widespread extravasation of blood
into the uterine musculature and
beneath the uterine serosa
Clinical Features
 Abruptly,persistent abdominal pain with
vaginal bleeding
 Maternal compromise/ shock(Volume of
vaginal bleeding not correspond to patient
condition)
 Anomaly of fetal condition
 The uterus touched hard with pain
 The size of uterus is bigger than it should
be in that gestation age
Auxiliary examination
Diagnotic examination:
B-ultrasound examination
Placenta examination post partum
Blood Rt,Blood coagulation,blood
examination of hepatic and renal
function
Sonography
Differential diagnosis
• Placental previa
• Uterus rupture
Complications
DIC,dysfunction of coagulation
Post partum hemorrhagic/shock
Amniotic fluid embolism
Acute renal failure
Fetal death
Management
Treatment depends on:
• Condition of the mother and fetus
• Gestational age of the fetus
• Cervical examination
Principle:
If diagnosed,fetus will be deliveried
immediately
Management
Mature fetus
Deliver
Compromised mother
Deliver
Immature fetus
Expectant, if mother stable
Expectant Management
• Bed rest
• Ongoing maternal monitoring
• Fetal assessment: age, growth, well
being
• Deliver if recurrent signs / symptoms
• Deliver at fetal maturation
Severe placental
abruption:
•
•
•
•
•
Resuscitation
Evaluate and treat coagulation defect
Deliver the fetus: Cesarean section
Prevention of PPH
Monitor renal status closely