Placenta Praevia

This is where the placenta is sited in the lower uterine segment, in front of the presenting part.

Epidemiology

  • 1% of pregnancies
  • More common in multiparous women, multiple pregnancy or if there has been a previous C-section

Pathophysiology/Typing

  • Bleeding is from the maternal circulation- occurs when the lower segment begins to stretch and the placenta is separated from the uterus
    • However, there is risk of foetal hypoxia in severe bleeds.

Clinical Features

  • Can have a varied amount of blood loss
    • May be recurrent
    • Usually fresh blood
  • Painless
  • Soft uterus- foetus easy to palpate
  • High presenting part- foetus not engaged
  • Malpresentation is common- breech/transverse
  • Usually no foetal distress on CTG
  • NB DO NOT PERFORM VAGINAL EXAMINATION UNTIL PLACENTA PRAEVIA HAS BEEN EXCLUDED

Diagnosis

  • Ultrasound will usually show a low lying placenta

Management

  • Manage any shock/blood loss etc
  • If type I and there is no bleeding (and no other complications) it may be suitable to watch and wait.  HOWEVER
  • Most cases will require admission and caesarian at 38 weeks (sooner if significant haemorrhage)
    • steroids, anti-D etc should also be given (as per routine)
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