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    Management of Placenta Praevia

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    tejabommina
    This document provides guidance on the management of placenta praevia, which is when the placenta partially or fully blocks the cervix. It recommends adequate prenatal care including ultrasound exams to diagnose the condition. For a warning hemorrhage at home, it advises bed rest, assessing blood loss, and transporting the patient to the hospital for IV fluids and potential blood transfusions. At the hospital, treatment depends on gestational age, fetal/maternal status, and hemorrhage extent, and may involve either expectant management with bed rest to delay delivery or active management with delivery by cesarean section or potentially vaginal delivery if the placenta edge is higher. Both expectant and active management

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    Management of Placenta Praevia

    Uploaded by

    tejabommina
    39 views22 pages
    This document provides guidance on the management of placenta praevia, which is when the placenta partially or fully blocks the cervix. It recommends adequate prenatal care including ultrasound exams to diagnose the condition. For a warning hemorrhage at home, it advises bed rest, assessing blood loss, and transporting the patient to the hospital for IV fluids and potential blood transfusions. At the hospital, treatment depends on gestational age, fetal/maternal status, and hemorrhage extent, and may involve either expectant management with bed rest to delay delivery or active management with delivery by cesarean section or potentially vaginal delivery if the placenta edge is higher. Both expectant and active management

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    gayatri

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    Gayatri

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    This document provides guidance on the management of placenta praevia, which is when the placenta partially or fully blocks the cervix. It recommends adequate prenatal care including ultrasound exams to diagnose the condition. For a warning hemorrhage at home, it advises bed rest, assessing blood loss, and transporting the patient to the hospital for IV fluids and potential blood transfusions. At the hospital, treatment depends on gestational age, fetal/maternal status, and hemorrhage extent, and may involve either expectant management with bed rest to delay delivery or active management with delivery by cesarean section or potentially vaginal delivery if the placenta edge is higher. Both expectant and active management

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    39 views22 pages

    Management of Placenta Praevia

    Uploaded by

    tejabommina
    This document provides guidance on the management of placenta praevia, which is when the placenta partially or fully blocks the cervix. It recommends adequate prenatal care including ultrasound exams to diagnose the condition. For a warning hemorrhage at home, it advises bed rest, assessing blood loss, and transporting the patient to the hospital for IV fluids and potential blood transfusions. At the hospital, treatment depends on gestational age, fetal/maternal status, and hemorrhage extent, and may involve either expectant management with bed rest to delay delivery or active management with delivery by cesarean section or potentially vaginal delivery if the placenta edge is higher. Both expectant and active management

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 22

    MANAGEMENT OF PLACENTA

    PRAEVIA
    PREVENTION
    Adequate antenatal care
    Antenatal diagnosis with ultra sound at 20
    weeks and repeat at 34 weeks to confirm
    diagnosis
    Warning hemorrhage should not be ignored
    Color flow doppler USG in placenta praevia is
    indicated to detect any placenta accreta

    AT HOME
    Immediate bed rest
    Asses blood loss
    a)Inspection of clothings soaked with blood
    b)Note the pulse ,BP ,degree of anemia
    Quick but gentle abdominal examination
    Vaginal examination must NOT be done
    TRANSFER TO HOSPITAL
    I.V Dextrose saline drip should be started and is
    kept running during transport
    Patient should be accompanied by two or three
    persons fit for donation of blood if necessary
    ADMISSION TO HOSPITAL
    All the cases of Antepartum hemorrhage should
    be admitted
    REASONS:
    a)All the cases of Antepartum hemorrhage
    should be regarded as due to placenta praevia
    unless proved other wise
    b)The bleeding may reoccur
    TREATMENT ON ADMISSION
    Immediate attention
    Formulation of the line of treatment
    IMMEDIATE ATTENTION
    ASSESS:
    1. Amount of blood loss
    2.Blood samples are taken for grouping and
    estimation of haemoglobin
    3.Infusion of normal saline
    4.Gentle abdominal palpation for uterine tenderness
    and auscultation to note fetal heart
    5.Inspection of vulva to note active bleeding
    Confirmation of diagnosis from history,examination
    and with SONOGRAPHIC EXAMINATION


    Formulation of line of treatment
    It depends upon:
    Duration of pregnancy
    Fetal and maternal status
    Extent of hemorrhage
    EXPECTANT TREATMENT
    AIM:
    To continue pregnancy for fetal maturity without
    compromising maternal health

    VITAL PREREQUISITES:
    1.Blood for transfusion
    2.Facilities for cesarean section should be
    available through out 24 hours

    Selection of cases:
    1.Mother in good health status
    2.Duration of pregnancy less than 37 weeks
    3.Active vaginal bleeding is absent
    4.Fetal well being is assured (USG)

    Conduct of expectant treatment
    1.Bed rest
    2.Investigation like hemoglobin estimation, blood
    grouping and urine for protein are done
    3.Periodic inspection of vulval pads
    4.Suppelementary hematinics
    5.Speculum examination to exclude local lesions
    for bleeding
    6.Use of tocolytics if associated with uterine
    contractions

    Preterm delivery is done in conditions such as:
    1.Reccurence of brisk hemorrhage and which is
    continuing
    2.Fetus is dead
    3.Fetus is congenitally malformed on investigation
    Steroid therapy is indicated when the duration
    of pregnancy is less than 34 weeks .
    Betamethasone reduces the risk of respiratory
    distress of new born
    ACTIVE MANAGEMENT(DELIVERY)
    INDICATIONS:
    1.Bleeding occurs at or after 37 weeks of
    pregnancy
    2.Patient is in labour
    3.Patient is exsanguinated on admission
    4.Bleeding is continuing and of moderate degree
    5.The baby is dead or congenitally deformed
    DEFINITIVE MANAGEMENT(DELIVERY)
    CESAREAN DELIVERY where placental edge is
    within 2cms from internal os.Wider use of
    cesarean section reduces maternal risk and
    improves fetal salvage
    VAGINAL DEIVERY where placental edge s 2-
    3cms away from internal os.

    VAGINAL EXAMINATION
    It should be done with a double set up
    arrangement in OT keeping everything ready for
    C-section
    CONTRAINDICATIONS:
    1.Patient in exsanguinated state
    2.Major degree of placenta praevia
    3.Associated complicating factors like
    malprsesentation,elderly primi gravidae etc


    LOW RUPTRE OF MEMBRANES:
    It is done using long kochers forceps in less
    degree of placenta praevia

    Finger is reinserted to exclude cord prolapse
    PRECAUTIONS DURING VAGINAL
    DELIVERY
    Restore blood volume
    Methergin 0.2 mg given intravenously with the
    delivery of anterior shoulder to prevent blood
    loss in third stage
    Proper examination of cervix soon following
    delivery to detect any evidences of tear
    Babys blood hemoglobin level is checked and if
    needed blood transfusion is done
    GENERAL REMARKS IN CESAREAN
    SECTION
    TYPE-LOWER SEGMENT
    CLASSICAL
    LOWER UTERINE CESARIAN SECTION:
    Advantages :conservant technique
    2. decision to preserve or remove the
    uterus can easily be made
    3.placenta accreta if accidentally met
    can also be tackled effectively


    Disadvantages:
    1.Whole blood shuld be made available
    2.Engorged vessels may bleed profusely when they
    are cut
    3.Anteriorly situated placenta,the placenta may
    have to be cut or seperated to deliver the baby
    4.Fetal exsanguination
    Claasical cessaren section
    Advantages:
    1.Operation can be done more quickly
    2.Baby is delivered without disturbing the
    placenta ,no fetal exsanguination
    Drawbacks:
    1.Lower segment over which placenta is implanted
    cannot be visualised and difficult to control
    bleeding
    Practical guide to lower segment
    approach
    To make infraumbilical longitudnal incision
    To tackle placenta lying underneath the incision
    After the placenta is expelled out the lower
    segment should be inspected for any oozing
    point which is over sewed if needed
    Tight intrauterine pack for hemostasis
    Atonic uterus
    Isthmic cervical apposition suture
    Babys blood hemoglobin levelis to be checked at
    birth
    Thank you

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