1. NAVEENA.R.L’09.
Management of preterm labour in
Placenta previa and
Abruptio placentae
NAVEENA.R.L.
09

2. PLACENTA PREVIA
 It is a condition in which the placenta is located
over or very near the internal os.
 Four degrees:
Total placenta previa.
Partial placenta previa.
Marginal placenta previa.
Low lying placenta.

4. CLINICAL FEATURES
SYMPTOMS:
 Painless bleeding.
 Causeless bleeding.
 Recurrent bleeding.

5. SIGNS:
 Tachycardia or hypotension
 Anemia
 Uterus relaxed.Fetal parts easily felt.
-Vaginal examination must not be done.
DIAGNOSIS:
Transvaginal sonography.

6. Management of preterm labour in
placenta previa
 Diagnosis should be confirmed.
 Admit the patient.
 Management depends on,
 quantity of bleeding.
 overall physical condition of the mother.
 Overall fetus condition and fetal maturity.

7. Expectant line
of management
Active line of
management

8. Expectant line of management:
Macafee-Johnson’s regime
 Aim is to continue pregnancy for fetal lungs to
mature without compromising maternal health.
VITAL PREREQUISITES:
 Availability of blood transfusion.
 Facilities for caesarean section should be available
24 hrs.

9. Cases suitable for expectant
management:
 Mother is in good health: Hb>10 gm%;
haematocrit>30%.
 Duration of pregnancy <37 weeks.
 No active vaginal bleeding.
 Fetal wellbeing assured by USG.

10. Conduct of expectant treatment:
 Bed rest.
 Hb%, blood grouping, Urine protein.
 Fetal surveillance with USG.
 Blood transfusion to correct anemia.
 Tocolytics- Given if vaginal bleeding is associated with
uterine contractions.
 Corticosteroids to improve fetal lung maturity and
reduce respiratory distress.
 Rh immunoglobulin given to all Rh negative mothers.

11. Termination of expectant
treatment:
 It is carried upto 37 weeks of pregnancy and then
the baby becomes sufficiently mature after which
pregnancy is terminated.

12.  Preterm delivery may have to be done in
conditions such as,
 Recurrence of brisk haemorrhage which is continuing.
 Fetus is dead.
 Congenitally malformed fetus found on investigation.
However,there is a risk of IUGR with expectant
management.
When an early delivery is needed fetal
amniocentesis is done to find out whether the fetal
lungs are ready to breathe well.

13. Active line of management:
LOWER SEGMENT CAESAREAN DELIVERY- done for all
women with sonographic evidence of placenta previa
where placental edge is within 2 cm from internal os.
VAGINAL DELIVERY: when placenta edge is clearly 2-3 cm
away from internal os.

15. ABRUPTIO PLACENTAE
 It refers to a condition where antepartum heamorrhage
occurs due to premature seperation of a normally situated
placenta.
TYPES:
 Concealed: Blood is retained within the uterine cavity
and is not visible exernally.Retroplacental clot present.
 Revealed: In this the blood collected due to placental
seperation escapes by dissecting under the membranes
and seen externally if memabranes are ruptured.Blood
stained liquor may occur.
 Mixed

16. TYPES:

17. Clinical features:
 Abdominal pain and bleeding PV.
 Signs:
 Features of PIH.
 Shock.
 Uterine height may or may not correspond to the
period of amenorrhea.
 Uterine tenderness and difficulty in palpating fetal
parts in concealed variety.
 Fetal heart may be normal,abnormal or absent.
 Uterine contractions.

18.  Bleeding is almost always maternal.
Clinical Classification:
Grade 0- No clinical features,diagnosed after delivery
after seeing retroplacental clot.
Grade 1- Slight vaginal bleeding, Uterine tenderness
minimal or absent,BP and fibrinogen level
unaffected,FHS good.
Grade 3- Mild to moderate vaginal bleeding,uterine
tenderness,maternal pulse increased,BP
maintained,fibrinogen decreased,Fetal distress.
Grade 4-Severe bleeding,tender uterus,Fetal
death,Associated coagulation defect or anuria.

19.  COUVELAIRE UTERUS or uteroplacental apoplexy
includes severe forms of placental seperation with
widespread extravasation of blood into uterine
musculature.

20. Management:
Active line of
treatment

21.  ACTIVE MANAGEMENT is the main
mode of managing Abruptio placentae.
 In Expectant management:
Risk of sudden seperation of
placenta and fetal death.So it is not
done.

22. SEVERE CASES:
Immediate delivery of the fetus is indicated either
by vaginal delivery or ceasarean section.
 So, once abruption sets in,it is difficult to prevent
preterm labour.

23.  Vaginal delivery indicated when,
 Limited placental abruption.
 FHR is reassuring.
 Continuous electronic fetal monitoring available.
 Placental abruption with a dead fetus.
• If patient is not in labour and bleeding continues
deliver by,
 Induction of labour by low rupture of membranes.
 Caesarean section.

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