Placenta Previa

Placenta previa is the low implantation of the placenta. The types of placenta previa are
the following:

1. Low-lying placenta previa the implantation took place in the lower portion rather than the
upper portion of the uterus.
2. Marginal placenta previa the placental edges are approaching the cervical os.
3. Partial placenta previa a portion of cerval os is occluded by the placental portion.
4. Total placenta previa implantation that totally obstructs the cervical os.

Risk factors
Increased parity
Advanced maternal age
Past cesarean births
Past uterine curettage
Multiple gestation

Signs and Symptoms

Bleeding bright red blood. The lower uterine segment begins to differentiate with the
upper segment later in pregnancy. Placenta has the inability to stretch to accommodate
the differeing shape of the lower uterine segment or the cervix, thus, abrupt and bright red
bleeding occurs.
Painless bleeding
Sudden bleeding

Abruptio Placenta
In this condition, the placenta has been implanted correctly, however the placenta
separates prematurely.

Incidence
It occurs in about 10% of pregnancies and is the most common cause of perinatal death.

Risk factors
High parity
Advanced maternal age
A short umbilical cord
Chronic hypertensive disease
Pregnancy-induced hypertension
Direct trauma
Vasoconstriction from cigarette use
Thrombophilitic conditions that lead to thrombosis such as autoimmune antibodies

Signs and symptoms

Sharp, stabbing pain high in the uterine fundus (during initial separation)
Tenderness felt on uterine palpation
Heavy bleeding (not readily apparent). Blood can either pool under the placenta and be
hidden from view. External bleeding is only present if the placenta separates first at the
edges and blood escapes freely from the cervix.
Hard, boardlike uterus with no apparent or minimally apparent bleeding
Dark red blood (in bleeding episodes)
Difference Between Placenta Previa and Abruption Placenta
Category Placenta Previa Abruptio Placenta
Problem Low implantation of the placenta Premature separation of the placenta
Incidence It occurs in approximately 5 in every 1000 It occurs in about 10% of pregnancies and is
pregnancies the most common cause of perinatal death.
Bleeding Always present May or may not be present
Color of blood in Bright red Dark red
bleeding episodes
Pain during PAINLESS SHARP, STABBING PAIN
bleeding
Management Bed rest (side lying position) Fluid replacement
NO vaginal or pelvic examinations Oxygen by mask
Assessment of FHR and bleeding Monitor FHR
Lateral position Keep the woman in a lateral position
No vaginal or pelvic examinations DO NOT perform any vaginal or
Termination of pregnancy pelvic examinations or give enema
Pregnancy must be terminated
Therapeutic Management because the fetus cannot obtain
1. Place the woman immediately on bed adequate oxygen and nutrients. If
rest in a side-lying position. birth does not seem imminent,
2. Weight perineal pads. cesarean birth is method of choice
3. NEVER attempt a pelvic or rectal for delivery.
examination because it may initiate
massive blood loss.

Ectopic Pregnancy
For pregnancy to happen, the ovary has to release an egg into the fallopian tube, where it
stays for about 24 hours. There it has to come in contact with a sperm to be fertilized. The fertilized
egg stays in the fallopian tube for 3 or 4 days before it heads to the uterus. There it attaches to the
lining and continues to grow until a baby is born.
But if the fertilized egg implants in your fallopian tube or somewhere else in your abdomen,
you end up with whats called an ectopic pregnancy. In these cases, the pregnancy cant continue
normally, and it requires emergency treatment.

Symptoms. Most of the time, an ectopic pregnancy happens within the first few weeks of
pregnancy. You might not even know you're pregnant and may not have signs of a problem.
Light vaginal bleeding and pelvic pain are usually the first symptoms, but others could include:

Nausea and vomiting with pain

Sharp abdominal cramps
Pain on one side of your body
Dizziness or weakness
Pain in your shoulder, neck, or rectum
Ectopic pregnancy can lead to fallopian tube rupture. If that happens, you could have major pain
and severe bleeding. Call your doctor immediately if you have heavy vaginal bleeding that causes
lightheadedness, fainting, or shoulder pain.

Causes. You may never know why you have an ectopic pregnancy. One cause could be a
damaged fallopian tube. It could prevent the fertilized egg from getting into your uterus, leaving it to
implant in the fallopian tube or somewhere else.
But you are more likely to have an ectopic pregnancy if you have any of the following:

Pelvic inflammatory disease (PID)

Sexually-transmitted diseases
Scarring from previous pelvic surgeries
History of ectopic pregnancy
Unsuccessful tubal ligation or tubal ligation reversal
Use of fertility drugs
Infertility treatments such as in vitro fertilization (IVF)

It could also happen if you become pregnant with an intrauterine device (IUD) in place.

Diagnosis. If your doctor thinks you have an ectopic pregnancy, she will probably perform some
tests, including a pregnancy test and a pelvic exam. An ultrasound test may be performed to view
the uterus and fallopian tubes condition.
If she confirms you have an ectopic pregnancy, she will talk to you about the best treatment based
on your medical condition and your future plans for pregnancy.

Treatments.
Medication. If your fallopian tube hasnt ruptured and your pregnancy hasnt progressed
very far, your doctor can give you an injection of methotrexate (Trexall). It stops the cells from
growing, and your body will simply absorb them. Most ectopic pregnancies can be treated with
methotrexate if theyre caught early.
Surgery. In other cases, surgery is required. The most common is laparoscopy. Your doctor
will make very small incisions in your lower abdomen and insert a thin, flexible instrument
(laparoscope) to remove the ectopic pregnancy. If your fallopian tube is damaged, she may have to
remove it as well.If youre bleeding heavily or your doctor suspects your fallopian tube is ruptured,
you might need emergency surgery with a larger incision. This is called laparotomy.

After an Ectopic Pregnancy. There is a good chance you can have a normal pregnancy again,
but it might be hard. You should consider talking to a fertility specialist early, especially if you had a
fallopian tube removed.
And talk to your doctor about how long to wait before trying again. Some doctors suggest at least 3
to 6 months. If youve already had an ectopic pregnancy, your chances of having another one go up.