PLACENTA PREVIA REMASTERED Presentation[1].pptx

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1.                                                                                                                                                NANDINI SAHA REG NO: 122016101082 PLACENTA PREVIA – INVESTIGATION , MANAGEMENT AND COMPLICATIONS

2. INVESTIGATION ULTRASOUND IT IS THE MOST SIMPLE , PRECISE AND SAFE METHOD FOR PLACENTAL LOCALISATION. A PARTIALLY FULL BLADDER IS NECESSARY TO IDENTIFY THE LOWER EDGE OF THE PLACENTA . IF IT IS LESS THAN 3CM FROM THE MARGIN OF THE INTERNAL OS, IT IS DIAGNOSED. THE POSTERIOR PLACENTA PREVIA IS DIFFICULT TO BE IDENTIFIED DUE TO SHADOWING FROM THE PRESENTING PART OF FETUS . THIS CAN BE OVERCOME BY HEAD DOWN TILT OF THE PATIENT OR DISPLACING THE PRESENTING PART MANUALLY IF DIFFICULTY STILL PRESENT , THE DISTANCE BETWEEN THE PRESENTING PART AND THE PROMONTORY OF THE SACRUM IS MEASURED. IF THIS EXCEEDS 1.5 CM IT MEANS THAT PLACENTA LIES IN BETWEEN.

3. IN MID – PREGNANCY THE PLACENTA REACHES THE INTERNAL OS IN UPTO 20% OF PREGNANCIES . WITH INCREASING GESTATIONAL AGE AND THE FORMATION OF THE LOWER UTERINE SEGMENT, A GAP DEVELOPS BETWEEN THE PLACENTAL EDGE AND THE INTERNAL OS KNOWN AS PLACENTAL MIGRATION. COLOUR DOPPLER FLOW STUDY MRI VAGINAL EXAMINATION

4. MANAGEMENT PREVENTION: TO MINIMIZE THE RISKS, THE FOLLOWING GUIDELINES ARE USEFUL: ADEQUATE ANTENATAL CARE SIGNIFICANCE OF WARNING HAEMORRHAGE. AT HOME : PUT PATIENT ON BED ABDOMINAL EXAMINATION VAGINAL EXAMINATION MUST NOT BE DONE TRANSFER TO HOSPITAL : ADMISSION TO HOSPITAL.

5. IMMEDIATE ATTENTION : TO ENSURE AN ADEQUATE BLOOD SUPLPLY TO A WOMAN AND FETUS PLACE THE WOMAN IMMEDIATELY ON BED REST IN A SIDE LYING POSITION A LARGE BORE IV CANNULA IS CITED AND INFUSION OF NORMAL SALINE GENTLE ABDOMINAL PALPATION.

6. VAGINAL DELIVERY IS ALLOWED IF THE FINDINGS ARE FULFILLED: PLACENTA PREVIA IS LATERALIS OR MARGINALIS ANTERIOR BLEEDING IS SLIGHT VERTEX PRESENTATION ADEQUATE PELVIS QITH SOFT TISSUE OBSTRUCTION PARTIALLY DILATED CERVIX TO ALLOW AMNIOTOMY

7. SCHEME OF MANAGEMENT ALL APH PATIENTS ARE TO BE ADMITTED EXPECTANT MANAGEMENT ACTIVE INTERFERENCE GENERAL AND ABDOMINAL EXAMINATION CLINICAL ASSESSMENT OF BLOOD LOSS RESUSCITATION IF NECESSARY LOCALISATION OF PLACENTA

8. EXPECTANT MANAGEMENT: THE EXPECTANT TREATMENT IS CARRIED UPTO 37 WEEKS. AIM: THE AIM IS TO CONTINUE PREGNANCY FOR FETAL MATURITY WITHOUT COMPROMISING THE MATERNAL HEALTH. INDICATIONS: NO ACTIVE BLEEDING PATIENT STABLE HAEMODYNAMICALLY FETAL HEART SOUND GOOD CTG- REACTIVE FETUS.

9. INTERVENTIONS: BED REST PERIODIC INSPECTION OF VULVAL PAD SUPPLEMENTARY HAEMATINICS IF PATIENT IS ANAEMIC USE OF TOCOLYTICS Rh IMMUNOGLOBULINS TO ALL Rh NEGATIVE WOMEN.

10. ACTIVE MANAGEMENT INDICATIONS : BLEEDING OCCURS AT OR AFTER 37 WEEKS OF PREGNANCY PATIENT IS IN LABOUR FETAL HEART SOUND IS ABSENT GROSS FETAL DEFORMATION DEAD FETUS.

11. ACTIVE MANAGEMENT CAN BE DIVIDED : VAGINAL DELIVERY CAESEREAN DELIVERY PLACENTAL EDGE IS WITHIN 2CM FROM THE INTERNAL OS: IN THIS CASE NO INTERNAL EXAMINATION IS PERFORMRD AND CAESARIAN SECTION IS CONSIDERED AS THE BEST CHOICE.

12. PLACENTAL EDGE IS 2-3 CM AWAY FROM INTERNAL CERVICAL OS:

13. COMPLICATIONS MATERNAL: DURING PREGNANCY : ANTEPARTUM HAEMORRHAGE WITH VARYING DEGRE OF SHOCK MALPRESENTATION PREMATURE LABOUR DURING LABOUR : EARLY RUPTURE OF MEMBRANE CORD PROLAOSE INTRAPARTUM HAEMMORHAGE

14. POSTPARTUM HAEMORHAGE AND SHOCK RETAINED PLACENTA FETAL COMPLICATION : LOW BIRTH WEIGHT ASPHYXIA INTRAUTERINE DEATH BIRTH INJURY