Supervised by: dr. Pim Gonta, Sp.OGCreated by:

Kevin Kristian (2012-061-144)Melissa Judi Koesyanto (2012-061-145)

Revy Aditya (2012-061-148)Dominicus Dimitri (2013-061-132)

Roswita Yohana Manek (2013-061-139)Maria Novilina Basso (2013-061-141)

Definition

Placenta previa is a condition in pregnancy which placenta is implanted over or very near the internall cervical ostium.

Classification

Total placenta previa: The placenta covers the internal cervical ostium completely.

Partial placenta previa: The placenta covers the internal cervical ostium partially.

Marginal placenta previa: The edge of the placenta is located at the marginal of the internal cervical ostium.

Low lying placenta: The placenta is implanted in the lower uterine segment, but the edge of it doesn’t reach the internal cervical ostium.

Risk Factor

Advancing maternal age Multiparity Multiple gestation (gemelli) Prior cesarean section delivery Maternal smoker Unexplained elevated screening

levels of alpha-fetoprotein

Pathophysiology

The bleeding in placenta previa is caused by the laceration of the placenta which resulted from the disengagement of the basal descidua to the uterine lining that caused by dilatation and effacement of the cervix.

The blood comes from the intervillus spaces of the placenta and it is ease by the uncontractable lower segment of the uterus.

Pathophysiology

The bleeding eventually will stop, but if the laceration is located in the bigger sinus, the bleeding be longer.

Since the formation of lower uterine segment is progressive, the laceration will re-occur, so do the bleeding.

The blood will flow freely from the cervical ostium since there are no tampon on the cervical ostium and retroplacental hematoma is not formatted.This also the reason why coagulopathy is rarely happens on patients with placenta previa

Pathophysiology

The lower uterine segment is thin and relatively weak and this cause the trophoblastic villus invade stronger to the uterine wall, that’s why placenta accreta and increta could happen.

Clinical Finding

Spontaneous and painless bleeding, usually appear on the end of second trimester or later.

Recurrent bleeding.

Diagnosis

Clinical findings. Bleeding after vaginal touchier. Ultrasonography

Transabdominal Trans perineal

MRI: for the detection of placenta accreta, increta or percetta.

Complication

Bleeding complication: shock. Placenta accreta, incretta and

percetta Placental retention.

Uterus Rupture. Premature birth. Placental abruption.

Management

Preterm fetus Hospitalization and close observation.

Blood group testing and sensitization in Rh(-) patients.

Discharge after the fetus is judged to be healthy and the bleeding stops.

In massive bleeding, MgSO4 is given to stop uterine contraction and steroid is given to maturate fetal’s lung, blood transfusion also considered.

Avoiding sexual intercourse.

Management and Prognosis

Management Delivery

Caesarian section with general anaesthesia.

Prognosis 47% premature birth. 2.5-fold fetal anomalies in placenta

previa.