Definition

PLACENTA PREVIA
Previa- going before; Placenta goes before the fetus into birth canal
Placenta is implanted in the lower uterine segment
Placental migration- movement of the placenta away from the internal
os.
o Migration- misnomer
Trophotropism- placental growth toward the fundus because of greater
upper uterine blood flow
Low lying placenta is less likely to migrate within a uterus with a prior
cesarean hysterotomy scar

Classification

Totalis- internal os is completely covered by placenta

Partialis- internal os is partially covered by placent
Marginalis- placenta is at the EDGE of internal os but did not overlie it
Low lying- placental does not reach the internal os and remains outside
(2 cm)

Risk factors

Increased maternal age

Multiparity
Prior cesarean deliviery
Cigarette smoking
Elevated MSAFP level
Painless bleeding- most characteristics

Clinical features

-profuse vaginal bleeding

-or initially minimal profuse bleeding

History

Abdominal Exam

Sentinel bleed- bleeding without warning/ pain

(-) pre eclampsia
Repeated warning hemorrhage
(-) abdominal pain

(-) tenderness
Normal uterine tone
Rarely in labor
Malpresentation is common
Fetal parts are usually palpable
(+) fetal heart tones
If bleeding is minimal, you cant appreciate deteriorating maternal and
fetal status
If profuse bleeding: deteriorating status
Uterus: soft

Ultrasound
MRI
Vaginal Examination

Placenta in lower uterine segment

- Transvaginal= most definitive
- MRI- for placenta accreta
Double setup reveals placenta implanted in lower uterine segment

Management

1. CLOSE OBSERVATION- preterm + no persistent bleeding

2. SCHEDULED ULTRASOUND- near term + not bleeding
Vertical incision- recommended
Low transverse hysterotomy- will cause bleeding if there is
an anterior placenta
3. HYSTERECTOMY- placenta accrete syndrome
4. PRESSURE 0-Chromic suture PELVIC ARTERY EMBOLIZATION
- For poorly contracted uterus
- uncontrollable hemorrhage after placental removal
General rule: Cesarean section except:
-low lying placenta
-marginalis
-anteriorly located placenta
Safe to deliver at 34-35 weeks: lung maturation is developed

Complications

NOTES

Increased perinatal mortality and morbidity

-most of the time secondary to preterm delivery
Hypovolemic shock
1. Dont do DIGITAL PALPATION- usually causes severe hemorrhage!!
2. VASA PREVIA- fetal vessels course through membrane & present at
the cervical os
3. SMOKING- increased the risk of placenta previa (2 fold)
4. PLACENTA ACCRETE SYNDROME- accrete, increta & percreta (ALAM
MO NIYO NA TO)
- Previa + Prior cesarean= high risk for accrete
5. Placenta previa is RARELY complicated by coagulopathy
6. Transabdominal sonography- imprecise results due to bladder
distention and large fundal placenta is not appreciated
7. Transvaginal UTZ- Superior
8. Transperineal UTZ= accurate to localize previa
9. WALANG MAGTOTOCOLYTICS sabi ni doc
10. Preterm delivery- major cause of perinatal death