1. Placenta Previa Ob & Gy Department, First Hospital, Xi ’ an Jiao Tong University SHU WANG

2. Definition This is where a placenta is inserted partially or wholly in the lower uterine segment. pictures

3. placenta Previa

5. Etiology  Endometrium disorder and injury  Massive placenta  Abnormal placenta  Germ cell with delay of trophblast developing

6. Classification  Complete placenta previa  Partial placenta previa  Marginal placenta previa

7. Clinical presentation  Manifestation I t characteristically presents with unprovoked and repeated painless vaginal bleeding.

8. Manifestation The classification of previa placenta sometimes determines the occurrence period and the volume of losing blood.

9.  symptom Severe blood losing leads to several shock signs,such as paleness,weak and quick pulse and hypotension. Malpresentation maybe exists,and floating presentation could be found during late gestational weeks.

10. Diagnosis  History  Symptom  Vaginal examination  Ultrasonography  Placenta and membrane examination after delivery

11. Differentiation diagnosis  Placental abruption  vessel Previa  Cervical polypus  Cervical erosion  Cervical carcinoma

12. Risk  Postpartum haemorrhage  Implanted placenta  Postpartum infection  Amnion fluid embolism  Premature delivery and increasing perinatal mortality

13. Treatment  Expectant delivery aim at achieving amixmum fetal maturity possible while minimizing the risk to both mother and fetus.

14. Expectant delivery The method apply to the patient with small and self-limited bleeding,and without fatal risk either to fetus or mother.

15. Immediate delivery  Indications:  When the bleeding is profuse and life is threatening, no matter the fetus is mature or unmature,alive or dead.  If bleeding continues but is neither profuse nor life threatening and the gestation is more than 34 weeks.

16.  Method  cesarean section  Transvaginal delivery  Emergency managment