Article on placenta previa

When the placenta is implanted partially or completely over the lower uterine segment is called as placenta previa.

Aetiology:

Multiparity can be the cause of placenta previa.
Increased maternal age
History of previous caesarean section
Placenta size and abnormalities

Sign and symptoms:

The most significant symptoms of placenta previa is bleeding in placenta.
Sudden onset painless, apparently causeless.
Generally anemia present in placenta previa

Abdominal examination:

The size of the uterus approximate to the period of gestation.
Uterus feels relaxed,soft and elastic.
The head is floating.
Fetal heart sound is usually present.

Degrees of placenta previa:

There are four types of placenta previa depending on the degree of extension of placenta to the lower segment.

Type -I :
The most part of the placenta is attached to this upper parts.

In the second stage placenta reaches the internal OS but does not cover it.

In the third stage the placenta completely cover the internal OS when closed but does not entirely do so when fully dilated .

In the fourth stage,the placenta completely covers the internal OS even after it is fully dilated.

Management: Placenta previa is one of inherent obstetrics hazards.So minimising the risk factors is useful and the guidelines are adequate antenatal care.

Antenatal diagnosis of low lying placenta.

Significance of warning haemorrhage should not be ignored.

Family planning and limitations of births is important.

Treatment on admission:

Bed rest is imposed for at least 2-3 days after the vaginal Bleeding ceases.

Investigation like haemoglobin estimation, blood grouping etc.

Periodic inspection

Supplimentary hematinics should be given and blood loss is replaced.
Premature termination can be done in the condition like recurrence of haemorrhage and which is continuing.
The fetus is dead.
The fetus is found congenitally malformations etc.
Termination after 37 completed weeks of pregnancy.
Posting for caesarean section is a best choice of treatment after completion of 37 weeks if the baby is alive and good.
If the dead baby is found induction of labour or termination is the treatment of choice.