1、Placetal PreviaLong Xiaoyu 龙晓宇XuanWu Hospital宣武医院Case 1. 30 G3P2 at 32 weeks gestation, painless vaginal bleeding.Four weeks ago , postcoital vaginal spotting 2. BP:110/70mmHg ,abdomen is soft uterus nontender , FHR :140-150bpmCase 1What is most likely diagnosis?What is your next step?Long-term mana
2、gement of this patient?What are the most common causes of Antepartum Hemorrhage ?COMMON CAUSES Placenta Previa Placental Abruption Preterm laborUNCOMMON CAUSES Uterine rupture Fetal(chorionic ) vessel rupture Cervical or vaginal lacerations Cervical or vaginal lesions, including cancer Congenital bl
3、eeding disorder Unknown ( by exclusion of the above) Placental Previa Understand that placenta previa and placental abruption are major causes of antepartum hemorrhage Know the painless vaginal bleeding is consistent with placenta previa Understand that the ultrasound examination is a good method fo
4、r assessing placental locationObjectives Defined as the inferior edge of placenta load at the lower uterine segment, or even reach the internal cervical os after 28 weeks gestation. Incidence rate:Internal： 0.24%1.57%；International： 0.5%0.9%。Placental Previa“ the placenta overlying the internal os o
5、f the cervix”Classification Classification Complete(central ) placenta previa Partial placenta previa Marginal placenta previa Low-lying placenta previaWhat are the risk factors for placental Previa?Question ETIOLOGYv Increased maternal agev Uterine factors: Previous CS Instrumentation of the uterin
6、e cavity (D and C for miscarriages or Induced Abortions)v Placental factors: Multiparity Multiple gestation Prior placenta previaETIOLOGY ManifestationIt characteristically presents with unprovoked and repeated painless vaginal bleeding.Clinical Presentation ManifestationThe classification of previa
7、 placenta sometimes determines the occurrence period and the volume of losing blood. Total placenta previa Early(20-28wks) Large amount Several timesPartial placenta previaBetween total and marginalBleeding time and volumeCentral placenta previaEarly(20-28wks)Large amountSeveral timesPartial placent
8、a previaBetween total and marginalMarginal placenta previaLate(37-40WKS or in labor ) Less bleedingsymptomSevere blood losing leads to several shock signs ,such as paleness ,weak and quick pulse and hypotension. Malpresentation maybe exists, and floating presentation could be found during late gesta
9、tional weeks.Complication of mother and fetusn Bleeding at or post partumn Implantation of placentan Anemia and puerperal infectionn Premature deliveryHow to diagnose the placental Previa?Question Patient History Placenta Previa Painless bleeding 2nd or 3rd trimester, or at term Often following inte
10、rcourse May have preterm contractions “Sentinel bleed”Physical Exam Placenta Previan The uterus is usually soft and relaxedn Anomaly of fetal conditionn Fetus is usually alive and welln Per vagina examination NO digital vaginal exam unless placental location knownAuxiliary examinationB-ultrasound ex
11、aminationl Ultrasound is the easiest, most reliable way to diagnose (95-98+% accuracy)l False positive- ultrasound with distended bladder l Transvaginal or transperineal often superior to transabdominal methods MRI Posterior previa High cost Limited availability Laboratory Placenta Previa Hematocrit
12、 or complete blood count Blood type and Rh Coagulation tests While waiting serum clot tube taped to wallDifferentiation diagnosis Placental abruption vessel Previa Cervical polypus Cervical erosion Cervical carcinomaManagement Expectant deliveryaim at achieving amixmum fetal maturity possible while
13、minimizing the risk to both mother and fetus.Management n expectant treatment Indication: Fewer vaginal bleedingPatients condition stabilization 36 weeks gestation,fetal weight2300g Management: Lying in bed to take a restInhibition of uterine contractionTreatment aim at symptomsPromote development of fetusPrevention of infection
