第一页，共二十九页。第二页，共二十九页。Importance•MaternalRisks–Acutehemorrhage–Operativedelivery•FetalRisks–Uteroplacentalinsufficiency–Prematurebirth•KeyPoints–Identifythecause–Timelyintervention第三页，共二十九页。InitialAssessment•History–Amountofbleeding,recentintercourseordigitalexam,severityofpain,trauma•Physicalexam–Vitalsigns,speculum,digitalonlyifnoplacentaprevia,maynotecervicitis/polyp/cancer•Ultrasound–Evaluationforplacentaprevia•Periodofobservation第四页，共二十九页。InitialManagementofSignificantBleeding•Hemodynamicinstability–Hypotension–Tachycardia•IVfluids•Considerbloodproducts/transfusion•Labtests–Hematocrit,platelets,fibrinogen,coagulation,bloodtype,andantibodyscreen•Continuousfetalmonitoring•Consideremergentcesareansection第五页，共二十九页。PlacentaPrevia•Complete–Coverstheinternalcervicalos•Marginal–Edgelieswithin2cmofinternalcervicalos•Lowlying–Edgelies2–3.5cmfromtheinternalos第六页，共二十九页。Image:://midwifemuse.files.wordpress/2022/02/previa.gif第七页，共二十九页。PlacentaPrevia(continued)•Notedinmid-pregnancyin40/1000pregnancies•Atterm,only4/1000•Bestvisualizedwithtransvaginalultrasound•Riskfactors–Increasedage–Increasedparity–Tobaccouse–Increasingnumberofcesareandeliveries第八页，共二十九页。PlacentaPrevia(continued)•Presentation•“painlessbleeding〞•Often“sentinelbleed〞inthelate2ndorearly3rdtrimester•Oftenaftersexualintercourse第九页，共二十九页。PlacentaPrevia(continued)•Management–Goalistopromotefetallungmaturity–Admittohospitalinitially–Administersteroidsif24-34weeksgestation–Considertocolytics–Outpatientmanagementinselectedsituations–Serialultrasounds–Ifdoesnotresolve,cesareandeliveryatterm第十页，共二十九页。PlacentaPrevia(continued)•Modeofdelivery–Ifunstable,immediatecesareandelivery–Ifstable,ultrasoundat36weeks•Ifplacentaledge>2cmfromos,vaginaldelivery•Ifplacentaledge1-2cmfromos,mayattemptvaginaldeliveryifoperatingroomnearby•Iffetallungsaremature,cesareanforcomplete...
