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MRCOG PART 2 SBAs and EMQs

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Placenta Previa

Placenta Previa Posted by Farzana N.
Bleeding in a case of known Placenta Previa is an obstetric emergency, which should be dealt with immediately. Management would include a quick assessment of amount of bleeding, resuscitation of patient if required and delivery by emergency caesarian section.
General condition of the patient assessed and vital signs taken. In case of mild bleeding
In presence of painful uterine contractions and gestational age 37 weeks, patient should be prepared for emergency c.s.Any delay would lead to profound bleeding with uterine contractions.
In case of moderate to severe bleeding, pt should be resuscitated first. Two wide bore canellas are inserted. Since the patient is admitted in the hospital, 4 units of cross-matched blood should be available. Blood should be collected for Hb, coagulation factors, urea and electrolytes.I.V fluids are given until the blood is available, patient should then be prepared for emergency caesarian section. .

During the hospital stay, pt should have b even adequately counseled about the type of placenta, possibility of emergency c.s, hemorrhage,. During the surgery, presense of placenta accreta or percreta and hysterectomy if bleeding remained UN controlled. Consent should be obtained. USG should be reviewed to know if the placenta is anterior or posterior.
Senior obstetrician should do the operation with a senior anesthetist. Consultant presence is mandatory during the operation. A regional block has risk of hypotension, but is accepted in experienced hands with the provision that it can be converted to general anesthetic if necessary. Adequate venous access must be in place before surgery. A CVP line to aid fluid replacement should be considered. Antibiotic coverage should be given.


The incision is commonly transverse lower segment. If difficulty encountered it may be converted to inverted T, J or U shaped incision. If the incision is transverse and placenta anterior approach may be 1) going through the placenta, this requires speed and results in fetal blood loss.2) Defining the edge of the placenta and going above or below it. This may be associated with undue delay in delivery of the fetus, fetal blood loss and anoxia. Hemorrhage encountered during the procedure can be controlled by use of syntocinon or ergometrine to correct uterine atony. PG F2 injected to control bleeding due to in adequately occluded placental sinuses. B-LYNCH suture, internal iliac artery ligation, or UAE may be undertaken depending upon the expertise present. Care should be taken that too much time is not spent in these procedures before recourse to hysterectomy is taken. Post partum prophylaxis for VTE should be given. Patient should be transferred to HDU for close monitoring.

Patient should be explained that .the condition might recur in future pregnancies.

A would require close observation.Bleeding in a case of known Placenta Previa is an obstetric emergency, which should be dealt with immediately. Management would include a quick assessment of amount of bleeding, resuscitation of patient if required and delivery by emergency caesarian section.
General condition of the patient assessed and vital signs taken. In case of mild bleeding
In presence of painful uterine contractions and gestational age 37 weeks, patient should be prepared for emergency c.s.Any delay would lead to profound bleeding with uterine contractions.
In case of moderate to severe bleeding, pt should be resuscitated first. Two wide bore canellas are inserted. Since the patient is admitted in the hospital, 4 units of cross-matched blood should be available. Blood should be collected for Hb, coagulation factors, urea and electrolytes.I.V fluids are given until the blood is available, patient should then be prepared for emergency caesarian section. .
. During the hospital stay, pt should have b even adequately counseled about the type of placenta, possibility of emergency c.s, hemorrhage,. During the surgery, presense of placenta accreta or percreta and hysterectomy if bleeding remained UN controlled. Consent should be obtained. USG should be reviewed to know if the placenta is anterior or posterior.
Senior obstetrician should do the operation with a senior anesthetist. Consultant presence is mandatory during the operation. A regional block has risk of hypotension, but is accepted in experienced hands with the provision that it can be converted to general anesthetic if necessary. Adequate venous access must be in place before surgery. A CVP line to aid fluid replacement should be considered. Antibiotic coverage should be given.
The incision is commonly transverse lower segment. If difficulty encountered it may be converted to inverted T, J or U shaped incision. If the incision is transverse and placenta anterior approach may be 1) going through the placenta, this requires speed and results in fetal blood loss.2) Defining the edge of the placenta and going above or below it. This may be associated with undue delay in delivery of the fetus, fetal blood loss and anoxia. Hemorrhage encountered during the procedure can be controlled by use of syntocinon or ergometrine to correct uterine atony. PG F2 injected to control bleeding due to in adequately occluded placental sinuses. B-LYNCH suture, internal iliac artery ligation, or UAE may be undertaken depending upon the expertise present. Care should be taken that too much time is not spent in these procedures before recourse to hysterectomy is taken. Post partum prophylaxis for VTE should be given. Patient should be transferred to HDU for close monitoring.

Patient should be explained that .the condition might recur in future pregnancies.