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

• Increasing maternal age

• fibroids

• multiparity

• previous Caesarean section

• Twins

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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