Placenta praevia true are:
Ans. A (Incidence increase by two fold after LSCS) "The incidence ranges from 0.5 - 1 % amongst hospital delivers.In 80% cases, it is found to multiparous. (i.e., not 1 per 1000 pregnancies)- Dutta Obstetrics 6th/243"Increased family planning acceptance with limitation and spacing of birth, lowers the incidence of placenta previa - Dutta Obstetrics 6th/ 243 (i.e. It is less common in develoed countries than in developing countries)"Atonic uterus (80%)Q is the commonest cause of PPH"- Dutta Obstetrics 6th / 411"About 1/3rd (35%) cases of antepartum haemorrhage (APH) belongs to placeta praevta"- Dutta Obstetrics 6th / 243Risk of Placenta Previa after CS ; Short discussion (Option A correct)William Obstetrics 23rd/770: says# In a study of 30, 132 women in labor undergoing cesa rean delivery, Silver and associates (2006) cited an increased risk of praevia in women who had prior caesarean delivery. The incidence was 1.3 percent for those with one prior cesarean delivery and 3.4 percent in women who has six or more cesarean deliveriesMiller and associates (1996) cited a threefold increased risk for praevia in women with a prior cesarean delivery in more than 150,000 deliveries at Los Angeles County Women's Hospital and the risk for previa increases progressively as parity and number of prior cesarean deliveries increase.# Gesteland and co-workers (2004) and Gilliam and colleagues (2000) calculated that the likelihood of previa was increased more than eightfold(r) in women with parity greater than four and more than four prior cesareans."The probability of placenta previa is four times greater- in patients with prior cesareans than in patients without uterine scars"- Fernando Arias 3rd/333Placenta Praevia# It is a rare condition in which the placenta grows in the lower part of a pregnant woman's uterus & covers all or part of the cervix.Aetiology:# Abnormal formation of placenta# S Abnormal uterus# Larges placenta# Scarred lining of the uterus (endometrium)Predisposing Factors:# Multi parity# Increased material age (>35 vrs.)# H/o previous LSCS or any scar in the uterus (myomectomy or hysterectomy)# Placental size & abnormality (Succenturiate lobe)# Smoking"Browne's classification for placenta previaType 1 LateralPlacenta dipping into the lower segment but reaching upto the os.Type 2 MarginalPlacenta edge reaches the internal os.Type 3 Incomplete centralPlacenta covers the internal os when closed, but not when fully dilated.Type 4 CentralPlacenta covers the internal os even fully dilated.# Type 1 and 2 are called minor degrees and type 3 and 4 called major degrees of placenta previa.# Type 1 and 2 can be anterior or posterior"# Type 2 posterior placenta is also called the 'dangerous type' as it is more likely to be compressed producing cord compression. This can cause fetal asphyxia and even death. Fig: Degrees of placenta praevia with findings on vaginal examination
Incidence increases by two fold after LSCS
More common in primipara
Most common in developed countries
1 per 1000 pregnancies
Placenta Previa