产科学英文课件：11 Placenta previa.ppt

General considerations Definition In placenta previa, the placenta is implanted in the lower uterine segment and located over the internal os. It constitutes an obstruction of descent of the presenting part. Main cause of obstetrical hemorrhage Incidence 0.24%-1.57% (our country). Etiology Uncertain High risk factors maternal age: 35 years multiparity: 85% - 90% prior cesarean delivery: 5 times smoking Etiology Causes Endometrial abnormality Scared or poorly vascularized endometrium in the corpus. Curettage, Delivery, CS and infection of endometrium Placental abnormality Large placenta (multiple pregnancy), succenturiate lobe (副胎盘) Delayed development of trophoblast Classification Total placenta previa The internal cervical os is covered completely by placenta Partial placenta previa The internal os is partially covered by placenta Marginal placenta previa The edge of the placenta is at the margin of the intenal os. Pernicious placenta previa: history of CS; implant on the anterior wall of the uterus, placenta accreta (50%) classification Manifestation Painless hemorrhage The most characteristic symptom Time: late pregnancy (after the 28th gestation week) and delivery Characteristics: sudden, painless and large amount Cause of bleeding Mechanical separation of the placenta from its implantation site, either during the formation of the lower uterine segment, during effacement and dilatation of the cervix in labor. Rupture of the venous in the decidua basalis Manifestation Anemia or shock repeated bleeding→ anemia heavy bleeding→ shock Abnormal fetal position a high presenting part breech presentation (often) Diagnosis History Painless hemorrhage At late pregnancy or delivery History of curettage or CS Diagnosis Signs Abdominal findings Uterus: soft, relaxed, without tenderness. Contraction may be palpated. A high presenting part can’t be pressed into the pelvic inlet. Breech presentation Fetal heart tones maybe disap