placeta previa

7/28/2019 placeta previa

1/13

BY

Zahidah bt Zakaria

030.07.346

Kepaniteraan Ilmu Kandungan dan Kebidanan RSAL

Fakultas Kedokteran Trisakti


2/13

Describe a placenta that is

implanted over or very nearthe internal cervical os

Definition ofplacenta previa


3/13

RiskFactor

Maternalage

Multiparity

Priorcaesareandelivery

Smoked

cigarettes

Maternalserum alphafeto protein


4/13

Painless bleedingin 2nd trimester

and early 3rdtrimester

Development ofLUS and

effacement ofcervix

Intercourse andVaginal

examination


5/13

TransabdominalUS

Transvaginal US

TransperinealUS MRI


6/13


7/13

Conservative mx

Prolongation ofpregnancy by 4 wk afterinitial bleeding.

Bethamehasone to pts 2cm from cervix :Vaginal delivery


8/13

Bleeding

Sonographic

examination

Hospitalization

- IV cannula

-FBC/Type/Screening

-Tocolytic

-Steroid

-Blood transfusion

-Discharge afterfree from bleeding

for 48 H

Outpatient

Access to telephone

Responsible adult

Transportation available

Reasonable distance


9/13

Post partum hemorrhage (PPH) account for140,000 death/year or maternal death every 4min.

Significant contributor = abnormal placentation +caesarean delivery.

Profuse bleeding from LUS due to removal ofplacenta previa/ accreta is a challenging problem.

Management :

Conservative

Uterotonic Uterine packing Oversewing


10/13

Overdistendeduterus

High Parity

Prior PPH

Uterine Atony PPH

Conservative measure

Uterotonics

Uterine Packing

Oversewing

Intrauterine ballontamponade

Invasive Intervation

Ligation of uterine andhypogastric a.

Hysterectomy


11/13

Hysterotomy Incision

24 F foley catheterinserted, distal end pass

tru cervix and pull truvagina

Infused ballon et 60-100ml NS and traction

appliedHaemostasis achieved

Hysterotomy incisionclosed

Plastic glove tied atdistal end of catheter

500ml NS bag tide atdistal end of catheter as

traction

Postop : Oxytocin infusefor 12 H. 800mcg

misoprostol rectally and3 dose of cefazolin

Ballon left in situ for 18-24 hr


12/13

Discussion

LUS doesnt respond due to poor contractile natureUteroronics/

Uterine Massage

Slow down the bleeding but not completly .

Potential risk : injury to bladder, ureter and vascularestructureOversewing

Uterine pack/ IU ballons

IU pack was abandoned due to concealed hemorrhage,infection and trauma

Tamponade

Used for placental abnormalitiesEmergency

hysterectomy


13/13

Documents

placeta previa