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20140110221000527
1. Placenta previaPlacenta previa
Placental abruption
Women’s Hospital School of MedicineWomen’s Hospital School of Medicine
Zhejiang UniversityZhejiang University
Wang ZhengpingWang Zhengping
4. Definition
• Placenta previa:
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% 。
5. Etiology
• High-risk group
Age of gravida>35
Multipara
Pregnancy women used to tobacco or dope
• Initial etiologic agnet
Damage of endometria
Development of the trophoblastic layer of
fertilized ovum delayed
Anomaly of placenta
Cicatricial uterus due to cesarean section ,e.g.
6. Classification
Classified according to the relationship
between the edge of placenta and the
internal cervical os :
complete ( central ) placenta previa
partial placenta previa
marginal placenta previa
Time to determine classification : the last
examination before managed
9. Clinical Features
Painless 、 recurrent vaginal bleeding in
the second or third trimester of
pregnancy
Anemia,shock or even death corresponded
to the volume of vaginal bleeding
The uterus is usually soft and relaxed
Anomaly of fetal condition
Per vagina examination
10. • Total
placenta
previa
• Early(20-
28wks)
• Large
amount
• Several
times
Partial placentaPartial placenta
previaprevia
Between totalBetween total
and marginaland marginal
Marginal placenta
previa
Late(37-40WKS or
in labor )
Less bleeding
Bleeding time and volume
Central placenta previa
Early(20-28wks)
Large amount
Several times
Partial placentaPartial placenta
previaprevia
Between total andBetween total and
marginalmarginal
Marginal placenta
previa
Late(37-40WKS
or in labor )
Less bleeding
18. Management
expectant treatment
Indication: Fewer vaginal bleeding
Patient’s condition stabilization
<36 weeks gestation,
fetal weight<2300g
Management: Lying in bed to take a rest
Inhibition of uterine contraction
Treatment aim at symptoms
Promote development of fetus
Prevention of infection
19. Termination of pregnancy
Indication: 1.Severe vaginal bleeding
2.Gestation age >36 weeks, or fetal
lung function been matured
Mode of labor:According to the type of placenta
previa,volume of vaginal bleeding
and condition of gravia, et al.
Cesarean delivery is necessary in practically all women
with placental previa
20.
21. Transport in emergency condition
In the neighborhood
Initiatory management
23. Definition
Placental abruption: placenta in normal site
strip from the uterine parietal partially
or completely before the fetus
expulsion,after 20 weeks gestation or in
the delivery procedure.
Incidence rate: 0.46%~2.1%
Neonatal mortality: 200‰~428‰
24. Etiology
Angiopathy of vasa basalis
Mechanical agent
Venous pressure of uterus elevated abruptly
Volume of uterus deflated abruptly
Others: Age of gravida>35,multipara,
tobacco,dope
25. Classification
Classify according to vaginal bleeding or nor:
Dominant/Recessive/Mixed
Classify according to severity degree:
Light type < 1/3
Severe type > 1/3; > 1/2, Dead
fetus
27. Clinical Features
Abruptly,persistent abdominal pain with
vaginal bleeding
Maternal compromise/ shock(Volume of
vaginal bleeding not correspond to patient
condition)
Anomaly of fetal condition
The uterus touched hard with pain
The size of uterus is bigger than it should
be in that gestation age
32. Management
Treatment depends on:
• Condition of the mother and fetus
• Gestational age of the fetus
• Cervical examination
Principle:
If diagnosed,fetus will be deliveried
immediately