Placenta previa / abruption ch12
How is placenta previa diagnosed?
All women with painless vaginal bleeding post 20 weeks gestation should have trans abdominal ultrasound, Trans vaginal ultrasound. If this reveals normal placenta then a speculum exam to r/o local cause of bleeding. Coagulation profile obtained to r/o other causes of bleeding
When can a women go home with a dx of placenta previa?
Not experienced vaginal bleeding for at least 48 hours before discharge.
What is the major complication for the fetus?
Preterm birth, stillbirth, malpresentation, fetal anemia
when can abruption be confirmed?
after birth by visual inspection
Define "complete placenta previa
covers internal cervical os totally
define marginal placenta previa
edge of placenta seen on ultrasound to be 2.5 cm or closer to internal cervical os
define low lying placenta
exact relationship of placenta to cervical os has not been determined or apparent placenta previa in second trimester
What is the major complication for the mother?
hemorrhage. If not controlled hysterectomy may be necessary.
When should antenatal corticosteroids be administered?
if fetus less than 34 weeks gestational age.
What are some risk factors for placental abruption?
maternal hypertension, cocaine, blunt external abdomen trauma, cigarette smoking, history of abruption, thrombophilias
describe expectant management for placenta previa
observation and bed rest if fetus less than 36 weeks gestational age and normal FHR, bleeding mild and stops, women not in labor. This allows fetus time to mature
What is placenta previa characterized by?
painless, bright red bleeding during 2 or 3 trimester
Define placenta previa
placenta implanted in lower uterine segment, completely or partially covers the cervix or is close enough to cervix to cause bleeding when cervix dilates or the lower uterine segment effaces
What are some risk factors for developing placenta previa?
previous cesarean birth, advanced maternal age. greater than 35 - 40. multiparity, smoking, higher altitude, induced abortion
Define placental abruption
seperation occurs in area of decidua basalis post 20 weeks gestation and before birth
What are some classic symptoms for placental abruption?
vaginal bleeding, abdominal pain, uterine tenderness and contractions
