Placenta praevia

An incorrect position of the placenta previa is when the placenta called ( placenta ). The placenta is nested in this case near the cervix and the birth canal is covered entirely or partially. From a placenta previa is spoken until after the 24th week of pregnancy, as it is previously still possible that the placenta grows upward.

Frequency

At about 0.5 % of all pregnancies, with more - or multi- parturient are affected much more frequently than first-time mothers, in particular by fast consecutive pregnancies.

Causes

The causes are not clearly understood. A frequent occurrence is found after previous caesarean section, miscarriage, manual removal of the placenta ( the placenta has not resolved itself after the birth and had to be surgically removed ), scrapes and several previous births.

Classification

The classification depends on the relationship of the placenta ( placenta ) to the internal os, which can occur a change in placenta praevia - form by an increasing cervical dilatation. A distinction is made:

  • Deep seat of the placenta: a part of the placenta is in the lower part of the uterus (lower uterine segment ). A vaginal birth is possible
  • Placenta praevia marginalis: the placental tissue reaches the internal os, a vaginal delivery may be possible, but depending on maternal and infantile state
  • Placenta previa partialis: the cervix is ​​partially overlaid by placental tissue, a vaginal birth is not desirable
  • Placenta previa: the placenta is centrally located on the inner cervix, a vaginal delivery is not possible. It may even come to life-threatening bleeding with low labor.

Symptoms

The main symptom of placenta previa is the advertising ( warning ) vaginal bleeding, usually in the middle of pregnancy. This bleeding is in contrast to hemorrhage in premature detachment of the placenta painless, fresh, bright red and recurring. The pregnant woman has no contractions, the abdomen is soft and non- tender. The Placenta previa can also be accompanied by the following infractions: the baby's head has not yet included in first-time mothers near term no relation to the maternal pelvis or incorrect position or Poleinstellung ( breech, transverse position ).

Diagnosis

The diagnosis should be made on the basis of clinical symptoms to determine accurate ultrasound examination to determine the exact localization of the placenta, possibly speculum setting, but in no case by a vaginal examination, as this may lead to life-threatening bleeding.

Therapy

In the diagnosis of placenta previa further action by the intensity of bleeding, the condition of mother and child, gestational age and the type of placenta previa depends. A clarification (also for differential diagnosis of premature detachment of the placenta ) is necessary, possibly hospitalization.

For heavy bleeding for shock therapy takes the development of several large-bore access and an aggressive fluid resuscitation. An emergency caesarean section even after transport to the hospital is then necessary.

Source

  • Mändle, Opitz Kreuter, Wehling " The midwives book textbook of practical obstetrics ," Schattauer -Verlag, ISBN 3-7945-1765-2.
  • Disease in obstetrics and gynecology
  • Disease in emergency medicine
  • Prenatal
Breech birth Shoulder presentation Speculum (medical)
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