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Placenta Praevia


Placenta below the foetus

  • Type 1 - lower margin of placenta dips into lower segment

  • Type 2 - reaches internal os of cervix but does not cover it

  • Type 3 - covers internal os when closed but not when dilated

  • Type 4 - covers internal os even when cervix fully dilated

Epidemiology

  • 1in 200

Risk factors

Signs and symptoms

  • recurrent painless bleeding

  • usually begins around 32nd week but may be from late 2nd trimester

  • DO NOT DO VAGINAL EXAMINATION

Diagnosis

  • malpresentation / oblique lie

  • abdomen soft, non-tender

  • patients condition should reflect known blood loss

  • ultrasound

Management

  • patient to hospital

  • cross-match blood

  • steroids to encourage foetal lung maturation

  • examination in theatre, under anaesthetic unless fear of provoking torrential haemorrhage

  • minor bleeding - bed rest, avoid sexual arousal / orgasm

  • delivery by Caesarean section

 

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