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Placenta previa

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Placenta previa

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    1. Placenta previa

    3. Definition    Placenta previa is a condition that may occur during pregnancy when the placenta implants in the lower part of the uterus and obstructs the cervical opening to the vagina (birth canal). Chinese definition

    4. Incidence The incidence of placenta previa is approximately 1 out of 200 births. increases with each pregnancy, and it is estimated that the incidence in women who have had 6 or more previous deliveries may be as high as 1 in 20 births. doubled in multiple pregnancy (such as twins and triplets).

    5. Causes Endometrium factors: a scarred endometrium (lining of the uterus) Curretage for several times an abnormal uterus Placental factors Large abnormal formation of the placenta. Development retardation of fertilized egg

    6. Risk factors include multiparity (previous deliveries), multiple pregnancy, previous myomectomy (removal of uterine fibroids through an incision in the uterus), and a previous C-section (if the scar is low and close to the vaginal cervix region).

    7. classification Complete placenta previa Partial placenta previa Marginal placenta previa

    8. Clinical findings Symptoms    Spotting during the first and second trimesters Sudden, painless, and profuse vaginal bleeding in pregnancy during the third trimester (usually after 28 weeks) Uterine cramping may occur with onset of bleeding Bleeding may not occur until after labor starts in some cases

    9. Signs The uterus is usually soft and relaxed. The infant position is oblique ( // ) or transverse ( == ) in about 15% of cases. Fetal distress is not usually present unless vaginal blood loss has been heavy enough to induce maternal shock, placenta abruptio, or a cord accident occurs. No digital examination!

    10. Accessory examinations Ultrasonography: Accuracy 95% 34th week Postpartum examination of placenta and membrane 7cm

    11. Diagnosis Differential diagnosis

    12. Complications    Maternal complications major hemorrhage, shock, and death. Implanted placenta Anemia and infection Fetal complications Prematurity (infant is less than 36 weeks gestation) is responsible for about 60% of infant deaths secondary to placenta previa. Fetal blood loss or hemorrhage may occur because of the placenta tearing away from the uterine wall during labor. It may also occur with entry into the uterus during a C-section delivery.

    13. Treatment The course of treatment depends on the amount of abnormal uterine bleeding, whether the fetus is developed enough to survive outside the uterus, the amount of placenta over the cervix, the position of the fetus, the parity (number of previous births) for the mother, and the presence or absence of labor.

    14. Early in pregnancy, transfusions may be given to replace maternal blood loss. Medications may be given to prevent premature labor, prolonging pregnancy to at least 36 weeks. Beyond 36 weeks, the benefits of additional infant maturity have to be weighed against the potential for major hemorrhage.

    15. Cesarean section is the method for delivery. It has proven to be the most important factor in reducing maternal and infant death rates. ???

    16. Expectations (prognosis)    The maternal prognosis (probable outcome) is excellent when managed appropriately. This is done by hospitalizing those at risk who are exhibiting signs and symptoms, and by performing C-section delivery.

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