1.

Definiton
Placenta previa is an abnormally implanted placenta, placed totally or partially in the lower
segment of the uterus rather than in the corpus. When the cervix begins to efface and dilate, the
placenta separates, allowing bleeding from the open blood vessels.
前置胎盘是一种不正常植入的胎盘，完全或部分地放置在子宫的下段而不是在体中。当子宫颈开始渗出并
扩张时，胎盘就会分离，让开放的血管流血。
2. Type
Complete: The internal os is covered by the placenta.
Partial: A portion of the cervical os is covered by the placenta.
Marginal: The edge of the placenta extends to the edge of the cervical os.
完整:内部 os 被胎盘覆盖。
部分:颈部 os 的一部分被胎盘覆盖。
边缘:胎盘的边缘延伸到宫颈 os 的边缘。
3. Risk Factors
 History of previous cesarean birth, abortion.以前剖腹产出生的历史,堕胎。
 Advanced maternal age (more than 35 to 40 years of age)先进的母亲的年龄(35 至 40 岁以上)
 Multiparity 经产
 History of prior suction curettage之前抽吸刮除术的历史
 Smoking吸烟
 Women carrying male fetuses男性胎儿的妇女
 Women who had placenta previa in a previous pregnancy 妇女在怀孕前一个前置胎盘
4. Clinical Manifestation
 Painless bright red vaginal bleeding 无痛鲜红的阴道出血
 Anemia, shock
 Abnormal fetal position
 Abdominal examination usually reveals a soft, relaxed, non-tender uterus 腹部检查通常揭示了
一个柔软、放松,non-tender 子宫
 Fundal heihgt is often greater than expected for gestational age 宫高是经常为孕龄大于预期
5. Diagnoses
 Transabdominal Ultrasound
 NO INTERNAL EXAMINATION
6. Management
 Expectant Management- implemented if the fetus is at less than 36 weeks og gestation and
has a normal FHR tracing, the bleeding is mild(<250ml) and stops, and the woman is not in
labor 期待管理——实现如果胎儿是在低于正常妊娠 36 周 og,FHR 跟踪、出血轻微(< 250 毫升)和停止,
女人,不在于劳动
 Active Management- if the woman is at or beyond 36 weeks of gestaiton or bleeding is
excessive or persistent, immediate cesarean birth is indicated. 主动管理,如果女人是达到或超过
36 周 gestaiton 或出血过多或持续,需要紧急剖腹产出生
Expectant Management
 Hospitalized in a labor and birth unit for continuous FHR and contraction monitoring.
 Largebore IV access should be initiated immediately
 Initial laboratory tests include hemoglobin, hematocrit, platelet count, and coagulation
studies
 A “type and screen” blood sample should be maintained at all times
 If the woman is at less than 34 weeks of gestation, antenatal corticosteroids should be
administered.
 Placed on bed rest with bathroom privileges and limited activity
 No vaginal or rectal examinations are performed, and the woman is placed on “pelvic rest”
(nothing in the vagina)
 Ultrasound examinations a 2-3 weeks
 Fetal surveillance once or twice weekly
 Assess for bleeding
 WOF signs of preterm labor
 Can be managed at home but there should be no signs of bleeding for at least 48 hours
before discharge from hospital
Criteria for Home Care
 She should be willing and able to comply with activity restrictions (bed rest with bathroorr
privileges and pelvic rest);
 live within 20 minutes of the hospital;
 have access to a telephone, close supervision by family or friends in the home, and constant
access to transportation
Active Management
 Expectant management is terminated as soon as the fetus is matureif excessive bleeding
develops, active labor begins, or any other obstetric reason to end the pregnancy (e.g.,
chorioamnionitis)
 Continuous monitoring of maternal and fetal status
 Emotional support for the woman and her family is extremely important.
期待管理
在劳动力和生产单位连续住院 FHR 和收缩的监控。
应立即启动第四大口径访问
最初的实验室测试包括血红蛋白、比容、血小板计数、凝血的研究
血液样本应该保持
如果女人在小于 34 周的妊娠,应该如何服用产前皮质类固醇。
放在卧床休息与浴室特权和有限的活动
没有阴道或直肠检查执行,女人是放在“骨盆休息”(没有在阴道)
超声波检查 2 - 3 周的时间
胎儿监测一周一次或两次
评估出血
WOF 早产的迹象
在家可以管理但不应该有出血的迹象,至少在出院前 48 小时
家庭护理标准
她应该愿意并且能够遵守活动的限制(卧床休息 bathroorr 特权和骨盆 rest);
住在医院 20 分钟以内;
访问电话,家人或朋友在家里,密切的监督和不断获得运输
主动管理
准管理尽快终止胎儿 matureif 大出血发展,积极劳动开始,或任何其他产科原因终止妊娠(如绒毛膜羊膜炎)
连续监测的孕产妇和胎儿的地位
情感支持的女人和她的家人是非常重要的。