placeta previa
TRANSCRIPT
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BY
Zahidah bt Zakaria
030.07.346
Kepaniteraan Ilmu Kandungan dan Kebidanan RSAL
Fakultas Kedokteran Trisakti
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Describe a placenta that is
implanted over or very nearthe internal cervical os
Definition ofplacenta previa
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RiskFactor
Maternalage
Multiparity
Priorcaesareandelivery
Smoked
cigarettes
Maternalserum alphafeto protein
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Painless bleedingin 2nd trimester
and early 3rdtrimester
Development ofLUS and
effacement ofcervix
Intercourse andVaginal
examination
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TransabdominalUS
Transvaginal US
TransperinealUS MRI
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Conservative mx
Prolongation ofpregnancy by 4 wk afterinitial bleeding.
Bethamehasone to pts 2cm from cervix :Vaginal delivery
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Bleeding
Sonographic
examination
Hospitalization
- IV cannula
-FBC/Type/Screening
-Tocolytic
-Steroid
-Blood transfusion
-Discharge afterfree from bleeding
for 48 H
Outpatient
Access to telephone
Responsible adult
Transportation available
Reasonable distance
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Post partum hemorrhage (PPH) account for140,000 death/year or maternal death every 4min.
Significant contributor = abnormal placentation +caesarean delivery.
Profuse bleeding from LUS due to removal ofplacenta previa/ accreta is a challenging problem.
Management :
Conservative
Uterotonic Uterine packing Oversewing
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Overdistendeduterus
High Parity
Prior PPH
Uterine Atony PPH
Conservative measure
Uterotonics
Uterine Packing
Oversewing
Intrauterine ballontamponade
Invasive Intervation
Ligation of uterine andhypogastric a.
Hysterectomy
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Hysterotomy Incision
24 F foley catheterinserted, distal end pass
tru cervix and pull truvagina
Infused ballon et 60-100ml NS and traction
appliedHaemostasis achieved
Hysterotomy incisionclosed
Plastic glove tied atdistal end of catheter
500ml NS bag tide atdistal end of catheter as
traction
Postop : Oxytocin infusefor 12 H. 800mcg
misoprostol rectally and3 dose of cefazolin
Ballon left in situ for 18-24 hr
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Discussion
LUS doesnt respond due to poor contractile natureUteroronics/
Uterine Massage
Slow down the bleeding but not completly .
Potential risk : injury to bladder, ureter and vascularestructureOversewing
Uterine pack/ IU ballons
IU pack was abandoned due to concealed hemorrhage,infection and trauma
Tamponade
Used for placental abnormalitiesEmergency
hysterectomy
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