Placenta previa is the implantation of the placenta on the internal os or adjacent to him. Typically occurs after the 20th week in a bright red, non-painful vaginal bleeding. The diagnosis is made by transvaginal or abdominal ultrasound. Treatment includes bed rest with a slight vaginal bleeding before 36 weeks; is the fetal lung maturity detected in the 36th week, then a caesarean section. If it is a strong or refractory bleeding or fetal state is threatening, is immediate delivery, usually by Caesarean section, indicated.

A placenta previa can (Placenta previa totalis) covering the internal os completely or partially (placenta previa partialis) or the edge of the inner reach cervix (placenta previa marginalis); the low-lying placenta is 2 cm from the internal os, but without reaching him. The incidence of placenta previa is 1/200 births. A placenta previa during early pregnancy usually disappears with the increase in size of the uterus from the 28th week of pregnancy.

Placenta previa is the implantation of the placenta on the internal os or adjacent to him. Typically occurs after the 20th week in a bright red, non-painful vaginal bleeding. The diagnosis is made by transvaginal or abdominal ultrasound. Treatment includes bed rest with a slight vaginal bleeding before 36 weeks; is the fetal lung maturity detected in the 36th week, then a caesarean section. If it is a strong or refractory bleeding or fetal state is threatening, is immediate delivery, usually by Caesarean section, indicated. A placenta previa can (Placenta previa totalis) covering the internal os completely or partially (placenta previa partialis) or the edge of the inner reach cervix (placenta previa marginalis); the low-lying placenta is 2 cm from the internal os, but without reaching him. The incidence of placenta previa is 1/200 births. A placenta previa during early pregnancy usually disappears with the increase in size of the uterus from the 28th week of pregnancy. Risk factors include the following risk factors: multiparity Former cesarean uterine abnormalities that prevent normal implantation (eg fibroids, previous curettage.) Smoking multiple pregnancy Higher maternal age complications patients previa with placenta or low-lying placenta at an increased risk for fetal position and setting anomalies , premature rupture of fetal growth retardation, vasa previa and velamentous cord insertion of the umbilical cord (at the end of the placenta umbilical cord consists of divergent umbilical vessels that are surrounded only by fetal fetal membranes). In women with a history of cesarean section increases a placenta previa the risk of placenta accreta (placenta accreta); the risk increases significantly with the number of previous deliveries by caesarean section (of about 10% at a caesarean section to> 60% at> 4 caesarean sections). Symptoms and signs Most occur the symptoms for the first time in late pregnancy. Then all of a sudden can often use a painless vaginal bleeding. Not infrequently, the bleeding is bright red and very strong and can lead to hemorrhagic shock. In some patients, the bleeding is accompanied by uterine contractions. Diagnostic Transvaginal sonography A placenta previa is pulled in all women with vaginal bleeding after 20 weeks into account. In the presence of placenta previa increases the digital vaginal examination the bleeding may be as to trigger a sudden, massive bleeding; Therefore, a digital vaginal examination if a vaginal bleeding after 20 weeks occurs, as long contraindicated until placenta previa has been ruled by a transabdominal sonography. Although previa with placenta rather a strong, painless bleeding occurs placentae with bright red blood than with abortion, a clinical distinction is not yet possible. Thus, an ultrasound examination is often necessary to distinguish them. Transvaginal sonography is an accurate and reliable method to diagnose placenta previa. Tips and risks it comes to vaginal bleeding after 20 weeks must be before a manual examination previa placenta excluded by ultrasound. previa in all women with suspected symptomatic placenta to monitor the fetal heart rate is displayed. The amniotic fluid is tested to the 36th week of pregnancy to assess fetal lung maturity and to demonstrate the safety of childbirth at this time, unless it is an emergency before (the immediate delivery required). Treatment Hospitalization and bed rest before the 36th week of pregnancy. in the first phase of bleeding. Delivery when there is danger to the mother or fetus or fetal lungs are mature. In the first ( “sentinel”) phase of vaginal bleeding before 36 weeks, there is a therapy in hospitalization, altered resting behavior and avoidance of sexual intercourse, which is able to cause bleeding on triggering uterine contractions or by a direct injury. (Altered resting behavior includes a waiver of any activity that increases intra-abdominal pressure for a long time, for. Example, women should not be the most of the day on their feet.) If the bleeding ceases, is getting up and walking around and usually also allows the discharge from the hospital. Some doctors recommend corticosteroids to accelerate fetal lung maturity when early delivery may be necessary and a gestational present <34 weeks. Typically, patients are received during a second phase bleeding again stationary and until delivery observed. A delivery is indicated in the following situations: Strong or uncontrollable bleeding Pathological findings during the monitoring of the fetal heart Hemodynamic the mother Fetal lung maturity instability (usually around the 36th week of pregnancy) The maternity is almost always by cesarean section, but if a pregnant women with low-lying placenta of the baby's head effectively compressed in an advanced stage of birth, the placenta or when rapid birth is expected during pregnancy <23 weeks, a vaginal delivery is possible. A hemorrhagic shock is treated (shock: hemorrhagic shock). Prophylactically should be given Rh0 (D) immunoglobulin, when the mother is Rh-negative (fetal erythroblastosis: Prevention). Summary In a placenta previa is more likely to a strong, painless bleeding with bright red blood than a placental abruption, but a clinical distinction is not yet possible. The urgency of delivery is achieved by monitoring of fetal heart rate (see a fetal distress) determined, and the amniotic fluid is analyzed (assessment of fetal lung maturity). During the first bleeding phases before the 36th week hospitalization, changes in resting behavior and renunciation of sexual intercourse is recommended. Corticosteroids to accelerate fetal lung maturity can be considered if a birth approximately 34 weeks would be necessary. A birth is aimed at heavy bleeding, instability of the mother or fetus or confirmed fetal lung maturity.

Health Life Media Team

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