Placenta Previa:
a) Obstetrics and Gynecology:
- Branch of medical sciences dealing with diseases of the female reproductive system, the birth of children, and the care of women before, during, and after they give birth.
- Maternal mortality: death of women whilst pregnant or within 42 days of delivery, or termination of pregnancy, for any cause related to or aggravated by pregnancy or its management, but excluding death from incidental or accidental causes.
- Maternal mortality ratio: number of maternal death per 100,000 labors (middle and low-income countries have higher death rates of soon-to-be mothers)
- What is the main cause of maternal mortality?
infection? obstetric hemorrhage? gestational hypertension? coagulation disorders?
- Placenta previa:
1) DEFINITION:
- In later pregnancy, the placenta covers up partially or completely the cervix in the lower part of the uterus lower than fetal presentation.
- Normal cases placenta must be attached to the upper area of the uterus.
2) CLINICAL FEATURES:
- Vaginal bleeding: painless and recurrent (frequent small uterine contractions lead to separation of the placenta from uterus and bleeding occurs). No pain because the uterus is not damaged and inside the pressure is not high.
- Blood pressure and heartbeat is normal
3) CLASSIFICATION:
- Based on the location of the placenta to the internal opening of the cervix, the placenta previa can be divided into 3 categories:
1. Complete/ total type: Most dangerous. The placenta covers the entire cervix
2. Partial type: placenta partially covers the cervix
3. Marginal type: edge of placenta is at the edge of the internal opening
4. Low-lying type: placenta implants in the lower uterine segment but does reach the cervical opening.
- Different types of placenta previa show different clinical features and determine different treatments.
4a) DIAGNOSIS:
- Symptoms, signs, and examination = diagnosis
- Most cases bleeding is mild and patients' vital signs are fine (normal BP and HB) however in some cases bleeding may be very serious and HB increases and BP decreases because of blood loss.
- If placenta previa is suspected an ultrasound is conducted, if B ultrasound finds the placenta covers the cervix a diagnosis can be made. Patients with placenta previa should never do a pelvic examination which can cause the separation of the placenta from the cervix and uterus. This separation may cause uterine contraction and cause vaginal bleeding and may be fatal.
- Physical examination: soft and clear-shaped uterus, no tenderness
4b) DIFFERENTIAL DIAGNOSIS:
- Distinguish a disease or condition from others that present similar signs and symptoms.
- 3 causes of antepartum bleeding:
1. Placenta abruption: painful bleeding
2. Placenta previa
3. Cervical cancer complicating pregnancy
- pathological examination and colposcope (magnifies cells of the vagina)
5) TREATMENT:
- Treatment plan based on maternal and fetal factors:
A) EXPECTANT MANAGEMENT:
1. Good: the maternal condition is ok
2. Alive: the fetal condition is ok
3. Little: mild vaginal hemorrahage
4. Early: gestation is before 36 weeks
B) TERMINATION OF PREGNANCY:
1. Maternal condition is unstable
2. Fetal condition is unstable
3. Massive and severe vaginal hemorrhage
4. Gestation after 36 weeks
6) RISK FACTORS:
- Rate of PP is increasing (global prevalence is 5.2% in 1000 pregnant women; higher in Asian and African studies)
1. Previous diagnosis/ history of PP, very more likely to have it in later pregnancies
2. multiple gestations/ pregnancies
3. surgery on the uterus or uterine scar
4. alcohol use and smoking
b) Retrospect:
Q1. What is the main symptom? Vaginal bleeding
Q2. When does bleeding appear? Late pregnancy (30 weeks)
Q3. What are the features of bleeding? painless and recurrent