Materiały źródłowe

• #1 Placenta previa: Management – UpToDate

  https://www.uptodate.com/contents/management-of-placenta-previa

  Placenta previa refers to the presence of placental tissue that extends over the internal cervical os. The abnormal placental location can result in severe antepartum, intrapartum, and/or postpartum uterine bleeding. Other sequelae include the need for cesarean birth and a high risk for preterm birth. […] The management of pregnancies complicated by placenta previa is best addressed in terms of the patient’s clinical setting: […] Active antepartum bleeding […] Stable after one or more episodes of active antepartum bleeding.

• #2 Placenta Previa – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539818/

  Placenta previa is the complete or partial covering of the internal os of the cervix with the placenta. […] This situation prevents a safe vaginal delivery and requires the delivery of the neonate to be via cesarean delivery. […] This activity reviews the evaluation and management of patients with placenta previa. […] Describe the management of patients with placenta previa and how this varies with gestational age, presentation, and stability of the patient. […] With the diagnosis of placenta previa, the patient is scheduled for elective delivery at 36 to 37 weeks via cesarean section. […] However, some patients with placenta previa present with complications and require urgent cesarean sections at an earlier gestational age. […] Patients with excessive or continuous vaginal bleeding should be delivered via cesarean section regardless of gestational age.

• #3 Placenta previa – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-previa/diagnosis-treatment/drc-20352773

  If placenta previa is diagnosed during a routine exam, you’ll likely have more-frequent ultrasound exams to monitor any changes in the placenta. […] In many women diagnosed with placenta previa early in their pregnancies, the condition resolves on its own. As the uterus grows, the distance between the cervix and the placenta may increase. Also, the direction of growth of the placenta may be higher in the uterus, and the edges of placental tissue near the cervix may shrink. […] If placenta previa resolves, you may be able to plan for a vaginal delivery. If it doesn’t resolve, you’ll plan for a C-section delivery. […] Vaginal bleeding after 20 weeks is treated as a medical emergency. You may be admitted to the hospital’s labor and delivery unit. You and your baby will be monitored, and you may need a blood transfusion to replace lost blood.

• #4 Placenta Previa: Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/24211-placenta-previa

  Placenta previa can go away on its own if it’s found in the second trimester. Going away on its own means the placenta shifts upwards to the top of your uterus. […] Your healthcare provider will likely advise you to limit certain activities like exercise, squatting, jumping and lifting. These activities could cause bleeding. It’s best to discuss your day-to-day activities with your provider so they can suggest modifications as necessary.

• #5 Placenta Previa > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/placenta-previa

  Treatment includes avoiding vaginal intercourse, hospitalization, C-section delivery, blood transfusion. […] There are no treatments for placenta previa. If placenta previa persists until the time of delivery then a C-section is often the best and safest route of delivery. […] Management options for pregnant women with placenta previa can include: Avoidance of vaginal intercourse for the remainder of pregnancy, Hospitalization, to monitor a pregnant woman and the fetus for part of or the remainder of pregnancy if bleeding recurs, Emergency C-section delivery, if a premature fetus is in distress; doctors may give corticosteroid injections to help the baby’s lungs mature before delivery if the pregnancy has not reached 34 weeks, C-section delivery at 37 weeks pregnancy, if the fetus is not in distress, Blood transfusions, as needed, if the pregnant woman loses a significant amount of blood. […] In the majority of cases, a woman with placenta previa can safely deliver via C-section with no complications.

• #6 Placenta previa: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000900.htm

  Your provider will carefully consider the risk of bleeding against early delivery of your baby. After 36 weeks, delivery of the baby may be the best treatment. […] Nearly all women with placenta previa will need a C-section. If the placenta covers all or part of the cervix, a vaginal delivery can cause severe bleeding. This can be deadly to both the mother and baby. […] If the placenta is near or covering part of the cervix, your provider may recommend: reducing your activities, bed rest, pelvic rest, which means no sex, no tampons, and no douching. […] You may need to stay in the hospital so your health care team can closely monitor you and your baby. […] Other treatments you may receive: blood transfusions, medicines to prevent early labor, medicines to help pregnancy continue to at least 36 weeks, shot of special medicine called Rhogam if your blood type is Rh-negative, steroid shots to help the baby’s lungs mature. […] An emergency C-section may be done

• #7 Placenta Previa

  https://www.healthline.com/health/placenta-previa

  Most pregnant people with placenta previa will require pelvic rest. This typically includes abstaining from having sexual intercourse, limiting any procedures like an obstetrical check for dilation, and possibly restricting any exercises that may strain the pelvic floor. […] Doctors will decide how to treat your placenta previa based on: the amount of bleeding, the month of your pregnancy, the baby’s health, the position of the placenta and the baby. […] For cases of placenta previa with minimal or no bleeding, your doctor will likely suggest pelvic rest. This means refraining from putting anything into your vagina during pregnancy in order to prevent medical complications. […] In the case of heavy bleeding, your doctor will advise scheduling a cesarean delivery as soon as it’s safe to deliver preferably after 36 weeks. […] In the case of uncontrolled bleeding, an emergency cesarean delivery will have to be performed.

• #8 Placenta previa – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/placenta-previa/diagnosis-treatment/drc-20352773

  If you are at 36 weeks, you’ll likely have a C-section to deliver the baby. If you have extreme blood loss or there’s a risk to the health of you or the baby, an emergency C-section may be needed before 36 weeks. […] When there’s no bleeding, the treatment goal is to lower the risk of possible bleeding and to get you as close to your delivery date as possible. Your care provider will likely recommend you avoid the following: […] Even if you’ve had no bleeding during your pregnancy due to placenta previa or no bleeding since the first episode you’ll likely have a C-section delivery scheduled sometime between 36 and 37 weeks. […] If your delivery is planned before 37 weeks, your health care provider will offer you corticosteroids to help your baby’s lungs develop.

• #9 Placenta Previa – Gynecology and Obstetrics – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gynecology-and-obstetrics/antenatal-complications/placenta-previa

  Placenta previa is implantation of the placenta over or near the internal os of the cervix. […] Treatment is modified activity if minor vaginal bleeding occurs before 36 weeks gestation, with cesarean delivery at 36 to 37 6/7 weeks. […] If bleeding is severe or refractory or if fetal status is nonreassuring, immediate cesarean delivery is indicated. […] For a first (sentinel) episode of vaginal bleeding before 36 weeks, management consists of hospitalization, modified activity (modified rest), and avoidance of sexual activity, which can cause bleeding by initiating contractions. […] If the patient is stable, delivery can be done at 36 to 37 6/7 weeks. […] Delivery is indicated for any of the following: Heavy or uncontrolled bleeding, Nonreassuring results of fetal heart monitoring, Maternal hemodynamic instability. […] Delivery is cesarean for placenta previa. […] Cesarean delivery is indicated when the mother or fetus is unstable or, if mother and fetus are stable, at 36 to 37 6/7 weeks.

• #10 Placenta previa | March of Dimes

  https://www.marchofdimes.org/find-support/topics/pregnancy/placenta-previa

  Talk with your providers about ways to deal with placenta previa, which could include having a planned c-section (caesarean birth). […] Treatment depends on how far along you are in your pregnancy, the seriousness of your bleeding and the health of you and your baby. The goal is to keep you pregnant as long as possible. Your provider may recommend no vaginal exams or sex to prevent damage to the placenta and bleeding. Providers recommend c-section for nearly everyone with placenta previa to prevent severe bleeding. […] If you have a lot of bleeding, you may be treated by having new blood put into your body (blood transfusions). Your provider also may give you medicines called corticosteroids to help speed up development of your baby’s lungs and other organs in case a preterm delivery is needed. […] If you have severe bleeding due to placenta previa at about 34 to 36 weeks of pregnancy, your provider may recommend an immediate c-section. […] At any stage of pregnancy, an emergency c-section may be necessary if you have dangerously heavy bleeding or if you and your baby are having problems.

• #11 Placenta praevia | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/healthyliving/placenta-praevia

  Treatment aims to ease the symptoms and prolong the pregnancy until at least 36 weeks. […] Medical treatment aims to ease the symptoms and prolong the pregnancy. Options may include: Bed rest. Hospitalisation. Close monitoring, such as using a fetal monitor and regularly checking the mothers vital signs (for example, blood pressure). Blood transfusion for the mother. Avoiding any activity that triggers uterine contractions or irritates the cervix, such as sexual intercourse or orgasms. […] Treatment depends on a number of factors, including: Whether the placenta praevia is complete or partial, The exact location of the placenta, The amount of blood lost, The gestational age of the baby, The position of the baby, The health of the baby, The health of the mother.

• #12 Placenta Previa – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK539818/

  If at or greater than 36 weeks of gestation then cesarean delivery is recommended. […] A cesarean section should optimally occur under controlled conditions. […] If there is a concern for PAS then urology, general surgery, as well as interventional radiology should have involvement as well. […] The patient should have two large bore IV lines in place and blood crossed and matched. […] A vertical skin incision is the recommended incision for optimal exposure. […] If the placenta does not detach or partially detaches then the patient has PAS, and the placenta should remain in situ, the uterine incision closed, and a cesarean hysterectomy should follow. […] There is an option for conservative management in patients with PAS if the patient desires fertility. […] Patients with a low-lying placenta, placenta lies greater than 2cm from the cervical os, may qualify for a trial of labor but are at an increased risk for postpartum hemorrhage and emergent cesarean section compared to women with normal placentation. […] There is no consensus for the recommended mode of delivery for marginal placenta previa.

• #13 Placenta praevia – Wikipedia

  https://en.wikipedia.org/wiki/Placenta_praevia

  For those who are less than 36 weeks pregnant with only a small amount of bleeding recommendations may include bed rest and avoiding sexual intercourse. […] For those after 36 weeks of pregnancy or with a significant amount of bleeding, cesarean section is generally recommended. […] In those less than 36 weeks pregnant, corticosteroids may be given to speed development of the baby’s lungs. […] An initial assessment to determine the status of the mother and fetus is required. […] Although mothers used to be treated in the hospital from the first bleeding episode until birth, it is now considered safe to treat placenta praevia on an outpatient basis if the fetus is at less than 30 weeks of gestation, and neither the mother nor the fetus are in distress. […] Immediate delivery of the fetus may be indicated if the fetus is mature or if the fetus or mother are in distress.

• #14 Placenta Previa Medication: Tocolytics, Corticosteroids, Adrenergic Agonists

  https://emedicine.medscape.com/article/262063-medication

  No medication is of specific benefit to a patient with placenta previa. Tocolysis may be cautiously considered in some circumstances in order to administer antenatal corticosteroids. A review article concluded that there is no improvement in perinatal outcome with prolonged tocolytics, and tocolysis beyond 48 hours is not clinically indicated. […] Encourage patients with known placenta previa to maintain intake of iron and folate as a safety margin in the event of bleeding. […] There have been studies that report using prothrombin complex and recombinant factor VII to control hemorrhage associated with obstetric complications and placenta previa. […] Tocolytic agents prevent preterm labor or contractions. Some specialists advocate tocolytics to promote the time for expectant management of symptomatic placenta previa. They should only be used after consultation with an obstetrician.

• #15 Placenta Previa: Symptoms, Types, Causes, Risks, & Treatment

  https://www.medicinenet.com/pregnancy_placenta_previa/article.htm

  Women with placenta previa who experience heavy bleeding may require blood transfusions and intravenous fluids. In some cases, tocolytic drugs (medications that slow down or inhibit labor), such as magnesium sulfate or terbutaline (Brethine) are necessary. […] Corticosteroids may be given to enhance lung development in the fetus prior to Cesarean delivery.

• #15 Placenta Previa: Symptoms, Types, Causes, Risks, & Treatment

  https://www.medicinenet.com/pregnancy_placenta_previa/article.htm

  Placenta previa is diagnosed by an ultrasound examination. […] Treatment of placenta previa involves bed rest and limitation of activity. Tocolytic medications, intravenous fluids, and blood transfusions may be required depending upon the severity of the condition. […] Cesarean delivery is required for complete placenta previa. […] Treatment of placenta previa depends upon the: Extent and severity of bleeding, Gestational age and condition of the fetus, Position of the placenta and fetus, Whether the bleeding has stopped. […] Cesarean delivery (C-section) is required for complete placenta previa and may be necessary for other types of placenta previa. […] Women who are actively bleeding or who have bleeding that cannot be stopped will be admitted to the hospital for further care.

• #16 Placenta Previa Medication: Tocolytics, Corticosteroids, Adrenergic Agonists

  https://emedicine.medscape.com/article/262063-medication

  Steroids may be administered after consultation with a gynecologist, if vaginal bleeding is mild and intermittent, if the patient is not in labor, and if gestation is less than 37 weeks. […] Dexamethasone may be given to promote the development of the lungs in the fetus. […] Betamethasone helps to promote fetal lung maturity. […] Terbutaline acts directly on beta2-receptors to relax uterine contractions.

• #17 Placenta Praevia: Symptoms, Diagnosis, and Treatment | Doctor

  https://patient.info/doctor/placenta-praevia

  Tocolysis may be considered for women presenting with symptomatic placenta praevia or a low-lying placenta for 48 hours to facilitate administration of antenatal corticosteroids, but if delivery is indicated based on maternal or fetal concerns, tocolysis should not be used in an attempt to prolong gestation. […] Delivery should be arranged in a maternity unit with on-site blood transfusion services and access to critical care. […] Delivery timing should be tailored according to antenatal symptoms and, for women presenting with uncomplicated placenta praevia, delivery should be considered between 36+0 and 37+0 weeks of gestation. […] Late preterm (34+0 to 36+6 weeks of gestation) delivery should be considered for women presenting with placenta praevia or a low-lying placenta and a history of vaginal bleeding or other associated risk factors for preterm delivery. […] If pharmacological measures fail to control haemorrhage, intrauterine tamponade and/or surgical haemostatic techniques should be used sooner rather than later. […] Early recourse to hysterectomy is recommended if conservative medical and surgical interventions prove ineffective.

• #18 Placenta Previa: Symptoms, Causes, and Treatments

  https://www.webmd.com/baby/what-is-placenta-previa

  There’s no cure for placenta previa. The goal of treatment is to limit the bleeding so you can get as close as possible to your due date. […] Your doctor could give you medicine to prevent premature labor. They may also give you corticosteroid shots to help your baby’s lungs develop faster. Once they feel that the baby can be safely delivered (by about 36 weeks of pregnancy), they’ll schedule a C-section. If your bleeding won’t stop, you’ll need an emergency C-section, even if your baby is not full term. […] Treatment depends on: The amount of bleeding. If it’s light, your doctor might suggest you avoid activities including sex and exercise. If it’s heavy, you may need to go to the emergency room, stay in the hospital, and get a blood transfusion. […] The best treatment for placenta previa is delivery of the baby after 36 weeks.

• #19 Placenta praevia – Wikipedia

  https://en.wikipedia.org/wiki/Placenta_praevia

  Blood volume replacement (to maintain blood pressure) and blood plasma replacement (to maintain fibrinogen levels) may be necessary. […] The method of delivery is determined by clinical state of the mother, fetus and ultrasound findings. […] In minor degrees (traditional grade I and II), vaginal delivery is possible. […] RCOG recommends that the placenta should be at least 2 cm away from internal os for an attempted vaginal delivery. […] In cases of fetal distress and major degrees (traditional grade III and IV) a caesarean section is indicated. […] Caesarean section is contraindicated in cases of disseminated intravascular coagulation. […] An obstetrician may need to divide the anterior lying placenta. […] In such cases, blood loss is expected to be high and thus blood and blood products are always kept ready. […] In rare cases, hysterectomy may be required.

• #20 Placenta Previa Treatment & Management: Approach Considerations, Management of Vaginal Bleeding, Surgical Intervention

  https://emedicine.medscape.com/article/262063-treatment

  Always anticipate massive hemorrhage and preterm delivery in a woman with placenta previa. Document adequate preparation, including transfer to a higher level of care, if necessary. […] Hemostasis may be established by one or more of the following: Oversewing the placental implantation site, Bilateral uterine artery ligation (O’Leary stitch), Internal iliac artery ligation, Circular interrupted ligation around the lower uterine segment both above and below the transverse incision, Packing with gauze or tamponade with the Bakri balloon catheter, B-lynch stitch, Cesarean hysterectomy. […] The use of uterotonics, including methylergonovine maleate (Methergine), 15 methyl prostaglandin F2 alpha (Hemabate), concentrated oxytocin, or misoprostol are excellent pharmacological agents to help resolve uterine atony, the main cause of hemorrhage post-delivery.

• #21 Placenta Previa Treatment & Management: Approach Considerations, Management of Vaginal Bleeding, Surgical Intervention

  https://emedicine.medscape.com/article/262063-treatment

  Other options include surgical management, as listed above. Often a combination of medical and surgical interventions are utilized. […] In instances where significant bleeding ensues, rapid replacement of blood products is a priority. In such instances, activation of the Massive Transfusion Protocol is warranted, allowing for stabilization of a patients hemodynamic status by way of rapid supply and infusion of blood products. […] Expectant management with close observation is indicated in situations where the fetal gestational age is less than 36 weeks of gestation as long as reassuring fetal monitoring is present and vaginal bleeding has resolved or significantly decreased. Administration of betamethasone should be provided if gestational age is less than 34 weeks. If bleeding is severe or non-reassuring fetal monitoring is present then emergency cesarean delivery is indicated.

• #22 Placenta Previa Treatment & Management: Approach Considerations, Management of Vaginal Bleeding, Surgical Intervention

  https://emedicine.medscape.com/article/262063-treatment

  Predelivery placement of balloon catheters for angiographic embolization of pelvic vessels is a technique described in reducing blood loss associated with cesarean hysterectomy and provides the opportunity to manage potential postoperative bleeding with embolization rather than operative re-exploration.

• #23 What complications can affect the placenta? – NHS

  https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/placenta-complications/

  If the placenta is near or covering the cervix, your baby can’t be delivered through the vagina, so a caesarean section will be recommended. […] You may be advised to come into hospital at the end of your pregnancy so emergency treatment (such as a blood transfusion) can be given very quickly if you bleed. […] Breastfeeding your baby as soon as possible after the birth can help your womb contract and push the placenta out. […] Your midwife may also ask you to change your position (for example, by moving to a sitting or squatting position). In some cases, you may be given an injection of a medicine to help your womb contract. […] If these methods don’t work, a doctor may need to remove the placenta by hand. This can be painful, so you’ll be given an anaesthetic.

• #24 Placenta previa Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/placenta-previa

  Your provider will carefully consider the risk of bleeding against early delivery of your baby. After 36 weeks, delivery of the baby may be the best treatment. […] Nearly all women with placenta previa will need a C-section. If the placenta covers all or part of the cervix, a vaginal delivery can cause severe bleeding. This can be deadly to both the mother and baby. […] If the placenta is near or covering part of the cervix, your provider may recommend: […] You may need to stay in the hospital so your health care team can closely monitor you and your baby. […] Other treatments you may receive: […] An emergency C-section may be done if the bleeding is heavy and cannot be controlled.

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