2. Case Case A 32 years old woman,now pregnancy for 33 weeks.Last night during sleeping she suffered from severe painless vaginal bleeding without any cause,and the blee- ding stopped spontaneously 15 minutes later.Now the patient’s Bp is 90/60mmHg, P is 98 bpm.

3. Questions What is the possible disease the patient suffered from? What accessory examination should be done? How to manage the patient and what is the treating principle for this disease?

4. Key words placenta previa 前置胎盘 fetal presentation 胎先露 Trophoblastic 滋养叶的 succenturiate placenta 副胎盘 Engagement 衔接 placental murmur 胎盘血管鸣 Postpartum 产后 Anticipating therapy 期待疗法 cesarean section 剖宫产 vaginal delivery 阴式分娩 Placenta abruption 胎盘早剥

5. Placenta previa 前置胎盘

6. Contents of the lecture Definition Etiology ★ ClassificationClassification ★ Clinical manifestationClinical manifestation Diagnosis ★ ManagementManagement

7. Definition If the placenta is attached to the low segment of uterus,its low edge reaches or covers the internal OS of cervix and is below the fetal presentation,it is called placenta previa.placenta previa

8. Etiology Trophoblastic development Ⅰ. Trophoblastic development retardation retardation Ⅱ. Over large placenta Ⅱ. Over large placenta Ⅲ. Endometrial lesion and damage Ⅲ. Endometrial lesion and damage Ⅳ. Abnormal placenta:such as Ⅳ. Abnormal placenta:such as succenturiate placenta succenturiate placenta

10. 1 2 6

13. ※ Classification complete placenta previacomplete placenta previacomplete placenta previacomplete placenta previa partial placenta previapartial placenta previapartial placenta previapartial placenta previa marginal placenta previamarginal placenta previamarginal placenta previamarginal placenta previa

14. Complete placenta previa

15. Partial placenta previa

16. Marginal placenta previa Marginal placenta previa

17. ※ Clinical manifestation Symptoms signs

18. Symptoms vaginal bleeding: Painlessrecurrent without any cause

20. signs General condition :Anemia shock shock Abdominal examination : Abdominal examination : uterine size uterine sizeuterine sizeuterine size engagement of fetal presentation engagement of fetal presentationengagement of fetal presentationengagement of fetal presentation placental murmur placental murmurplacental murmurplacental murmur

21. uterine size uterine size

22. engagement of fetal presentation engagement of fetal presentation

23. Diagnosis Symptoms Body signs Vaginal examination Ultrasound examination Postpartum examination of placenta and fetal membranePostpartum examination of placenta and fetal membrane

24. Vaginal examination

25. Ultrasound examination

26. rupture

27. Management Anticipating therapy Termination of pregnancy 1.the indication of the termination of pregnancy 2.cesarean sectioncesarean section 3.vaginal deliveryvaginal delivery

28. cesarean section

29. vaginal delivery

30. Definition Etiology ★ Classification ★ Clinical manifestation Diagnosis ★ Management Summary of the lecture

31. Next lecture… Differentiation diagnosis Placenta abruption

32. Case Case A 32 years old woman,now pregnancy for 33 weeks.Last night during sleeping she suffered from severe painless vaginal bleeding without any cause,and the blee- ding stopped spontaneously 15 minutes later.Now the patient’s Bp is 90/60mmHg, P is 98 bpm.

33. Questions What is the possible disease the patient suffered from? How to manage the patient and what is the treating principle for this disease?