Minette B.

Emmanuel
ADZU-SOM Level 1

Placenta Previa Abruptio Placenta

Placenta implantation  over or very near the  Fundal portion of uterine
internal cervical os cavity
Incidence  1 in 300-400 pregnancies  1 in 200-300 pregnancies
 Philippines- 1 in 93  Philippines- 1 in 200-300
Risk Factors  Advancing maternal age  Advancing maternal age
 Race  Race
 Parity  Parity
 Multifetal pregnancy  Smoking
 Smoking  Familial
 Previous CS  Hypertension
 Large placenta  Premature rupture of
 Puerperal endometritis membranes
 Thrombophilia
 Trauma
 Cocaine
 Leiomyoma
 Recurrent abruption
Clinical Features  Painless bleeding  Bleeding with pain
 No abdominal pain  With abdominal pain
 Uterus is soft, non-tender,  Uterus is rigid, tender and
non-contractile contractile
 Fetal heart tone normal  Fetal heart tone bradycardia
 Usually not in labor  Idiopathic preterm labor
 Vaginal bleeding is bright red  Vaginal bleeding may be
bright red/dark brown
Diagnosis  Double set up exam  Retroperitoneal Clot
 Sonographic exam Formation
 MRI  Portwine colored amniotic
fluid
 Ultrasonography and
Doppler
 MRI
Management  Expectant management if  Usually no expectant
pre-term management as it leads to
delivery
 Vaginal delivery if:  Vaginal delivery if:
  Placental edge >20mm away
from internal os
 Cesarean delivery if:
 Placental edge ≤20mm away
from internal os
Complications  Rarely causes coagulation
failure
 Postpartum hemorrhage
 Intrauterine Growth
restriction
 Low birth weight
Prognosis  Good
 Fetus is dead
 Delivery is imminent
 Minimal hemorrhage
 Cesarean delivery if:
 Unsuccessful induction of
labor
 Fetal distress
 Obstetrical complications
 Failure of labor to begin
within four hours
 May lead to DIC
 Hypovolemic shock
 Couvelaire uterus
 Acute kidney Injury
 Sheehan syndrome
 Fetal death
 Fetal neurologic deficits
 Poor