PLACENTA PREVIA

Supervised by: dr. Pim Gonta, Sp.OG

Created by:
Kevin Kristian (2012-061-144)
Melissa Judi Koesyanto (2012-061-145)
Revy Aditya (2012-061-148)
Dominicus Dimitri (2013-061-132)
Roswita Yohana Manek (2013-061-139)
Maria Novilina Basso (2013-061-141)

Definition
Placenta previa is a condition in pregnancy which
placenta is implanted over or very near the
internall cervical ostium.
Classification
Total placenta previa: The placenta covers the
internal cervical ostium completely.
Partial placenta previa: The placenta covers
the internal cervical ostium partially.
Marginal placenta previa: The edge of the
placenta is located at the marginal of the
internal cervical ostium.
Low lying placenta: The placenta is implanted
in the lower uterine segment, but the edge of
it doesnt reach the internal cervical ostium.
Risk Factor
Advancing maternal age
Multiparity
Multiple gestation (gemelli)
Prior cesarean section delivery
Maternal smoker
Unexplained elevated screening levels of
alpha-fetoprotein
Pathophysiology
The bleeding in placenta previa is caused by
the laceration of the placenta which resulted
from the disengagement of the basal
descidua to the uterine lining that caused by
dilatation and effacement of the cervix.
The blood comes from the intervillus spaces
of the placenta and it is ease by the
uncontractable lower segment of the uterus.
Pathophysiology
The bleeding eventually will stop, but if the
laceration is located in the bigger sinus, the
bleeding be longer.
Since the formation of lower uterine segment is
progressive, the laceration will re-occur, so do
the bleeding.
The blood will flow freely from the cervical
ostium since there are no tampon on the cervical
ostium and retroplacental hematoma is not
formatted.
This also the reason why coagulopathy is rarely
happens on patients with placenta previa
Pathophysiology
The lower uterine segment is thin and
relatively weak and this cause the
trophoblastic villus invade stronger to the
uterine wall, thats why placenta accreta and
increta could happen.
Clinical Finding
Spontaneous and painless bleeding, usually
appear on the end of second trimester or
later.
Recurrent bleeding.
Diagnosis
Clinical findings.
Bleeding after vaginal touchier.
Ultrasonography
Transabdominal
Trans perineal
MRI: for the detection of placenta accreta,
increta or percetta.
Complication
Bleeding complication: shock.
Placenta accreta, incretta and percetta
Placental retention.
Uterus Rupture.
Premature birth.
Placental abruption.
Management
Preterm fetus
Hospitalization and close observation.
Blood group testing and sensitization in Rh(-)
patients.
Discharge after the fetus is judged to be healthy
and the bleeding stops.
In massive bleeding, MgSO
4
is given to stop
uterine contraction and steroid is given to
maturate fetals lung, blood transfusion also
considered.

Avoiding sexual intercourse.
Management and Prognosis
Management
Delivery
Caesarian section with general anaesthesia.

Prognosis
47% premature birth.
2.5-fold fetal anomalies in placenta previa.