placenta previa

DEFINITION
---After 28 weeks’ gestation
age ,the implantation of placenta is
in the lower segment of uterus
,margins of placenta are near or
over the cervical os.
 CLASSIFICATION

Complete(total or cental) placenta previa

Partial placenta previa

Marginal placenta previa

 ETIOLOGY
Multiparity
Previous cesarean delivery or uterus
operation
Large placenta:multiple fetuses 、
paraplacenta
Advancing age
Cocain use or tobacco use
Diagnosis

Symptoms
Signs
Ultrasonography
 Symptoms:
1 Vaginal hemorrhage( painless 、 repeat , bright
red)

Complete previa : begin early,about 28 weeks

times of that are more
with larger amount
Maginal previa: begin late,about37-40weeks
times of that are few
with little amount
partial previa: the times and the amount
are between the two others
 Signs:
The uterus uaually is soft,
size is fit for the gestation age
The presenting part is highable ,upon
the placenta

The maternal and fetal vital signs is

related with the amout of
hemorrhage.may be maternal shock
or anemia OR fetal distress
 Ultrasonography
It is sensitive in diagnosing (complete
,partial or marginal)

• Notice Prudent
the gestation age ( with
development of the lower segment ,it may
carried to a higher station )
 Postpartal examination of
placenta and membrane:
(a) black blood blots

(b) the distance from the rupture site

of membrane to the margin of
placenta-- less than 7cm
DIFFERENTIAL DIAGNOSIS
Not difficult
Placental abruption
Premature labor
Rupture of marginal sinus
Cervical erosion
Rupture of vasa previa
Polyp velamentous insertion of
cord
 Complication
1.Postpartum hemorrhage
,hemorrhagic shock.
2.Placent accreta,increta, percreta.
3 Infections.
4.Premature birth.
5.High fetal mortality.
 Management
Principles:Stop hemorrhage,Correct
anemia.
1.Expectant therapy.
Indications:(1)The pregnant week is less than 37
(the fetus is less than 2300g).
(2)Without active vaginal bleeding.
(3)The pregnant woman is in good
general condition
(4)The fetus is alive.
Expectant therapy:
(1)Hospitalization
(2)Absolute bed rest
(3)Avoid any vaginal or digital
examination
(4)Complete laboratory examination
(5)Preparation for blood transfusion
(6)Correct anemia
The expectant therapy bad better be
maintained until 37 pregnant week.
 2.Delivery
Indication:
(1)Hemorrhagic shock
(2)Repeat bleeding or great
hemorrhage
(3)fetal compromise
If the gestation age is between24 and 34
weeks ,steriod should be given to promote
lung maturity.
 C.S
Cesarean section. The most important management
for PP.
do careful preoperative preparation
fliud resuscitation or blood transfusion
performed as appropriate

incision:anterior previa
→vertical uterine incision
posterior placenta previa
→common transverse incision
cesarean hysterectomy : percreta placenta and
active bleeding or
uncontrolled hemorrhage
 Vaginal delivery
• Indications:marginal pacenta previa
• small vaginal bleeding
• fetal position is normal
• vaginal delivery is imment
• The patient should be prepared for
cesarean section
嵩山风景
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