Nonobstetric causes: cervicitis,
cervical polyps, cancer; vaginal varices.
In case of placenta previa -
placenta situated in lower uterine segment covering totally or partially the
internal cervical os. The incidence of placenta previa is about 0.5% at term.
prior cesarean section
large placenta (e.g. multiple gestation)
Total placenta previa
- the internal os is covered completely
Partial placenta previa
- the internal os is covered partially .
Marginal placenta previa -
the edge of the placenta is at the margin of the internal os.
Symptoms and signs:
sudden, painless and profuse vaginal bleeding
uterus usually is soft and nontender
no fetal disstress.
The type of treatment depends on:
amount of uterine bleeding
gestational age and viability of the fetus
Steroids for fetal lung maturation.
is the accepted method of delivery in practically all cases of placenta previa
Cesarean delivery should be performed as soon as lung maturity is documented, or
when hemorrhage is so severe as to mandate delivery despite fetal immaturity.
is defined as the separation of a normally implanted placenta from the uterine
site before the delivery of the fetus. Placental
abruption occurs in 0,5-1,8% of all pregnancies. About 50% of cases occur before
the onset of labor.
Grade I (mild).
The diagnosis of abruptio placentae is made retrospectively on postpartum
detection of a small retroplacental clot.
Grade II (intermediate). This
diagnosis is based on the classic features of abruptio placentae with uterine
hypertonicity, but the fetus is still alive.
Grade III (severe).
The fetus is dead (separation of 50% or more of the placental area usually is
incompatible with fetal life):
Overt coagulopathy is not present.
Overt coagulopathy results.
Placental abruption may be:
external (in about 80% of patients) or concealed
sudden severe abdominal (uterine) or back pain,
persistent uterine hypertonus,
evidence of fetal distress,
Patients with a mild placental abruption may be asymptomatic.
is indicated for:
if no fetal
when the fetus is dead and absence of life-threatening
Fluid and blood replacement
Correction of the coagulopathy
– if the fetus is immature, bleeding is small, no fetal distress, and uterine
irritability is absent:
tocolytics (contraversial opinion),
steroids for fetal lung maturation.