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Placenta Praevia

August 23, 2012  by: Nupur  Points: 12   Category: Health  Earning $0.25   Views: 562

Patients being diagnosed with placenta praevia should take precautions, keep in touch with their doctor till the pregnancy reaches term. Placenta praevia is not a condition to get worried about. The patients should have patience. They should co-operate with the treating doctor. This article will highlight the symptoms, investigations and management of placenta praevia.

         

What is placenta praevia?


Placenta praevia can be defined as a condition in which the placenta gets implanted at the lower end of a pregnant uterus or near the cervix. Sometimes it may even cover the cervix totally. This results in vaginal bleeding or spotting depending upon the type of placenta praevia.

What is placenta?


Placenta is the organ that connects the developing foetus to the wall of the uterus. Through this organ (cord) the foetus gets its nutrient requirements. As the foetus grows the waste materials get eliminated out through the placenta. The placenta is also responsible for the gaseous exchange needed for the growth and survival of the foetus in the mother’s womb.

Signs and symptoms of placenta praevia


  • The patient may complain of spotting ( blood spots) in the under-garments.

  • The patient may complain of recurrent, bright red vaginal bleeding. The bleeding is painless.

  • On investigation the haemoglobin % may be found to be lower than usual or below normal levels.

  • The patient may complain of tiredness or fatigue.

  • The symptom of nausea or vomiting may get enhanced, low blood pressure may be there ( in some cases).

  • On abdominal palpation in the 18th-20th week of gestation, features of malpresentation can be found.

  • The abdominal finding and the height of the uterus are not found to be proportionate with the gestational age of the foetus.

  • The foetal heart sounds (FHS) are usually found to be present on auscultation.


Types of placenta praevia


Placent praevia may present in four different forms:
  • The placenta is low lying, it dips in the lower segment of the uterus.

  • The placenta reaches the cervical os (opening of the cervix) but does not cover it.

  • The placenta partially covers the cervical os.

  • The placenta completely covers the internal os. The internal os remains covered with the placenta even on full dilatation of the cervix.


Note - Vaginal examination should not be done if there is any suspect of placenta praevia.

Investigation and diagnosis


It is important to diagnose a case of placenta praevia at the earliest. This prevents the loss of haemoglobin content (Hb%) of the mother’s blood. It aids towards a better management and prognosis of the foetus and the mother.

  • Ultrasonography (USG) is the best diagnostic tool for placenta praevia. If the ultrsonography shows a low lying placent in the 10-12th week of a gravid uterus, the patient should avoid doing heavy or strenuous work and should take rest. As the foetus grows, the uterus expands and the placenta is pulled away from the cervix in many cases. So the complications disappears gradually.

  • If ultrasound diagnoses placenta praevia in the 16-20th week of pregnancy. The cause should be taken up seriously. There are possibilities of the placenta moving upwards with the growth of the foetus. Depending upon the type of placenta praevia ( normal, partial, complete/major) the patient should be thoroughly investigated, managed and treated.


Incidence of placent praevia


Incidence of placenta praevia is high in the following cases:
  • Mother is above 35 years of age.

  • Multiparity.

  • History of pregnancy with placenta praevia.

  • History of having dilatation and curettage (D & C) done.

  • Multiple conception, multiple babies in the gravid uterus.


Management of placenta praevia


  • Delivery of the baby depends upon the type of placenta praevia. If the placenta acquires a position away from the lower segment of the uterus with the growth of the foetus, there is possibility of normal delivery.

  • If the placenta partially or completely covers the os, the decision of caesarean section is taken for the safety of the mother and the baby.

  • The patient diagnosed with partial or complete placenta praevia is advised bed rest for 36 weeks till pregnany reaches term. Blood transfusions may be required to maintain the haemoglobin level ( Hb%).

  • In case of bleeding the patient should be immediately hospitalized so that bleeding can be monitored, patient ‘s condition can be stabilized, foetal heart sounds can be noted, medications can be given to prevent the patient from getting pre-mature labour pains.

  • If the pregnancy is at term ( completed 36 weeks ) and patient bleeds heavily, blood transfusion should be done. Other symptomatic treatments should be started. The baby should be delivered out by caesarean section at the earliest.




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