placenta previa.pptx

This ppt about what actually required by itself placenta previa

1. Placenta previa Done by: Gulimzhan Yermakhanbet Checked by:

2. Definition Placenta previa is the complete or partial covering of the internal os of the cervix with the placenta. It is a major risk factor for postpartum hemorrhage and can lead to morbidity and mortality of the mother and neonate.

3. INCIDENCE Placenta previa affects 0.3% to 2% of pregnancies in the third trimester and has become more evident secondary to the increasing rates of cesarean sections https://www.ncbi.nlm.nih.gov/books/NBK539818/#article-27262.s2

4. ETIOLOGY The underlying cause of placenta previa is unknown. an association between endometrial damage and uterine scarring. The risk factors that correlate with placenta previa are advanced maternal age, multiparity, smoking, cocaine use, prior suction, and curettage, assisted reproductive technology, history of cesarean section(s), and prior placenta previa

5. The implantation of a zygote (fertilized egg) requires an environment rich in oxygen and collagen. The outer layer of the dividing zygote, blastocyst, is made up of trophoblast cells which develops into the placenta and fetal membranes. The trophoblast adheres to the decidua basalis of the endometrium, forming a normal pregnancy. Prior uterine scars provide an environment that is rich in oxygen and collagen. The trophoblast can adhere to the uterine scar leading to the placenta covering the cervical os or the placenta invading the walls of the myometrium. https://www.ncbi.nlm.nih.gov/books/NBK539818/#article-27262.s2

6. TYPES OF PLACENTA PREVIA

7. Complete PP and low-lying placenta were associated with the highest and lowest risks of adverse pregnancy outcomes, respectively, whereas clinically similar outcomes were observed between marginal and partial PP . The three-classification of PP may be practical from the clinical perspective. Bi, S., Zhang, L., Wang, Z. et al. Effect of types of placenta previa on maternal and neonatal outcomes: a 10-year retrospective cohort study. Arch Gynecol Obstet 304, 65–72 (2021). https://doi.org/10.1007/s00404-020-05912-9

8. Placental attachment site influenced the pregnancy outcome. Placental attachment to the anterior wall was associated with s horter gestational age, low birth weight, lower Apgar score, higher prenatal bleeding rate, increased postpartum hemorrhage, longer duration of hospitalization, and higher blood transfusion and hysterectomy rates compared to cases with lateral/posterior wall placenta. Placental attachment at the i ncision site of a previous cesarean section significantly increased the incidence of complete placenta previa and PAS disorders compared with placental attachment at a site without incision, but did not significantly influence pregnancy outcomes. Placental attachment to the anterior wall was an independent risk factor for postpartum hemorrhage in patients with placenta previa. Placental attachment to a previous incision site was an independent risk factor for PAS disorders. https://doi.org/10.1371/journal.pone.0200252

9. Effect of site of placentation on pregnancy outcomes in patients with placenta previa

10. Citation: Jing L, Wei G, Mengfan S, Yanyan H (2018) Effect of site of placentation on pregnancy outcomes in patients with placenta previa. PLoS ONE 13(7): e0200252. https://doi.org/10.1371/journal.pone.0200252

11. DIAGNOSTICS SYMPTOMS: Causeless, painless and recurrent bright-red vaginal bleeding; It is causeless, but may follow sexual intercourse or vaginal examination. It is painless, but may be associated with labour pains . It is recurrent, but may occur once in slight placenta praevia lateralis. Fortunately, the first attack usually not severe.

12. SIGNS General examination The general condition of the patient depends upon the amount of blood loss. Shock develops if there is acute severe blood loss and anaemia develops if there is recurrent slight blood loss.

13. Investigations Instrumental research: Ultrasound of the utero-placental complex, performed by transabdominal or transvaginal access; Dopplerography of the placenta (color, 3D); MRI to diagnose and determine the degree of invasion of the ingrown placenta. MRI is the method of choice for suspected posterior placenta ingrowth, and is also more informative in patients with a long gestation period and high obesity.

14. To make a diagnosis of placenta previa, you need to do the following : at 20 weeks of gestation, during screening, clarification of the location of the placenta and attachment pathology (placenta adherens, placenta accreta, placenta percreta) ; in the case of low-lying placenta, transvaginal sonography is performed at 25-26 weeks, which reclassifies 26-60% of cases ; In case of a scar on the uterus and the presence of the following aggravating factors: placenta previa or localization of the placenta along the anterior wall, it is necessary to repeat the ultrasound at 32 weeks of pregnancy to exclude placenta accreta. If the diagnosis is confirmed, the management and organization of observation of these pregnant women is carried out as in case of placenta accreta ;

15. At 36 weeks, a second ultrasound is performed in a group of pregnant women at high risk for placenta accreta and pregnant women with partial placenta previa to re-verify the diagnosis: Antenatal sonographic imaging may be supplemented by magnetic resonance imaging in doubtful cases, but a definitive diagnosis can only be made at the time of surgery; The diagnostic value of various ultrasound methods is presented

16. Treatment With complete PP, delivery is indicated only by caesarean section. With incomplete, marginal placenta previa, expectant management can be used until the spontaneous onset of labor at full-term pregnancy or the appearance of bloody discharge from the genital tract with the informed consent of the woman. Childbirth begin to lead through the natural birth canal. In childbirth, early amniotomy and continuous electronic monitoring of the fetus are indicated. With increased bleeding and / or signs of fetal suffering, childbirth should be completed with operative delivery.

17. Surgical intervention Name of surgery: C-section; compression hemostatic sutures; ligation of the uterine, ovarian, iliac arteries; hysterectomy; embolization of the uterine arteries. Indications: Bleeding from the genital tract after the 20th week of pregnancy in the presence of PP.

18. Uterine tamponade using a double-balloon catheter was as effective as gauze packing in hemostasis, and appeared to be superior in reducing postpartum blood loss and pain following CD for placenta previa. Using double-balloon catheter in managing PPH in this situation may be a preferable alternative to minimize maternal morbidity. doi: 10.1097/MD.0000000000019221

19. https://www.cureus.com/articles/32703-uterine-sandwich-method-a-case-of-posterior-placenta-previa-in-an-in-vitro-fertilization-pregnancy-complicated-by-velamentous-cord-insertion