Overview

• Low-lying placenta → overlies internal cervical os.
• Occurs in 0.5% of pregnancies.
• Risk Factors → multiple pregnancy, increased maternal age, previous uterine surgery, previous placenta praevia, smoking, IVF.
• Degree of Praevia

Making Diagnosis

Clinical Features

• Painless PV bleeding in 2nd or 3rd trimester.

Investigations

• Diagnosis → TVUSS.
  • Low-Lying → within 20mm of cervical os (praevia = covers os).
• Do NOT perform a bimanual examination - can provoke serious haemorrhage (speculum is okay to assess bleeding).

Management Plan

• General Advice ⇒

  • Not to have sex.
  • Delivery will be caesarean section.

• Low-Lying Placenta at 20-Week Scan (incidence = 5%) ⇒

  • Incidence at delivery = reduced to 0.5%. (90% MOVE AWAY FROM OS - only 10% still low lying at term).
  • Rescan at 32 weeks →
    • If still low-lying → rescan at 36 weeks
      • If still low-lying → elective caesarean section at 36-37 weeks (before allowing spontaneous labour to occur).

• Symptomatic Placenta Praevia with Bleeding ⇒

  • Admit until bleeding has stopped + for further 48 hours.
  • ABCDE Approach → 2x IV access + fluids.
  • Give anti-D immunoglobulin if rhesus negative.
  • Bloods → FBC, G&S, crossmatch.
  • Continuous fetal monitoring (attach CTG probe).
  • Decision on Delivery ⇒
    • Mother haemodynamically unstable or foetal distress → expedite delivery.
    • Mother haemodynamically stable + no foetal distress → give steroids and admit until bleeding has stopped + for further 48 hrs.

  <aside> 💡 IF ANTEPARTUM HAEMORRHAGE → ALWAYS ADMIT EVEN IF BLEEDING HAS STOPPED. (FOR UP TO 48 HOURS AFTER BLEEDING HAS STOPPED).

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