8、placenta previa.ppt

Placenta previa Dina sun Definition the placenta is implanted partially or completely over the lower uterine segment within the zone of effacement and dilatation of the cervix. The placenta lies below the fetal presentation. After 28 weeks Placenta previa is a severe obstetric complication. in the second and third trimesters of pregnancy. serious morbidity and mortality to both the fetus and the mother. the commonest causes of antepartum haemorrhage.( account for 20%) Incidence approximately 0.5%-1% of all pregnancy, account for 20% of all cases of antepartum hemorrhage. 90% of patient will be multipara. the major reason of hemorrhage: when the lower uterine segment is increasing in length, and shearing forces between the trophoblast and the maternal blood sinuses. Incidence The first episode of bleeding occurs: 60%---after 36weeks of gestational age. 30%---between 32-36weeks of gestational age. 10%---before 32weeks of gestational age. Etiology The etiology of placenta previa is not so clear, may be multifactorial. Eg. multiparity, multiple gestations, maternal advanced age (35yrs), previous cesarean delivery, previous abortion, and infaust living habit (smoking, drug abuse). Uterine paramorphia, the patient who received assisted reproductive techniques. Etiology 1. Endometrial lesion or injury. The common causes: abortion, curettage, puerperal infection, cesarean section, operative history of uterus, pelvic inflammation. Endometrial inflammation or atrophic lesions, poorly vascularized endometrium in pregnancy and insufficiency of placenta perfusion. To intake more nutrients the placenta increased its surface and extend to the lower uterine segment. scarring in the lower segment of the uterus --- hamper the removal of the placenta. ART make the difference between the endometrium and fetus development. Etiology 2. placental abnormality (size and shape) twin pregnancy----increased placental surface area succenturiate placenta, pseudoplac