LESSON PLAN

ON

placenta praevia

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 GENTR
AL OBJECTIVES:
After this class the students will be able to acquire knowledge in depth regarding definition, etiology, clinical
features, diagnosis, complications, medical management of placenta praevia.

SPECIFIC OBJECTIVES:

 .Define placenta praevia and Explain the etiological factors of placenta praevia.

 Describe the clinical symptoms & diagnosis of placenta praevia

 List down the complications of placenta praevia

 Describe the management of placenta praevia

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Sr. Time Specific content Teaching Av/aids evaluation
no objectives -learning
. activities
1. 10min. Define PLACENTA PREVIA: L Black What ar ethe causes
placenta DEFINITION: E board of placenta previa?
previa and when the placenta is implanted partially or C
explain the Completely over the lower uterine T
etiology of segment it is called as placenta previa. U
placenta R
Incidence: 0.5 – 1% among hospital
previa E
deliveries
C
80% cases – multiparous women
U
Age – 35 beyond M

ETIOLOGY: D
I
 dropping down theory
S
 persistence of chronic activity
C

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  defective decidua U
 big surface of the placenta S
S
I
O
N

2 10 Describe the PREDISPOSING FACTORS L Black Enemurate the

min. predisposing  Multiparity E board predisposing
factor and  Increased maternal age C factors & various
type of  H/o Caesarian section T degrees of placenta
degrees of  smoking U previa?
placenta R
Types of degrees:
previa E
There are four types of placenta
praevia depending upon the degree C

of extension of placenta to the lower U

uterine segment. M

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 TYPE -I(low-lying): the major part D
of the placenta is attached to the I
upper segment and only lower S
margin encroaches on to the lower C
segment but not upto the OS. U
Type -II(marginal): the placenta S
reaches the margin of the internal os S
but does not cover it. I
TYPE-III (incomplete or partial O
complete): the placenta covers the N
internal os partially

L Black
Clinical features
3. 15 Clinical E board Describe the sign
Symptoms: the only symptom is
min. features of C and symptoms of
bleeding
placenta T placenta previa?
the bleeding is painless, onset,
previa. U
apparently causeless and reccurent.
R
Signs: anaemia due to

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 blood loss E
Abdominal examination: C
 the size of uterus is U
proportionate to the period of M
gestation. D
 The uterus feels relaxed, soft I
and elastic without any S
localised area of tenderness. C
 Persistence of malpresentation U
like breech,or transverse S
or S
unstable lie. I
 The head is floating in contrast O
to the period of gestation N
 Fetal heart sound is usually
present
Vulval inspection: character of

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blood – bright red or dark red
coloured and the amount of blood
loss to be assessed from blood
stained clothings.
▪ In placenta praevia the blood
is bright red as the bleeding
occurs from the seperated
utero-placental sinuses close to
the cervical opening and
escapes out immediately
Vaginal examination – it must not
be done outside the operation theatre.
It can provoke further seperation of
placenta with haemmorhage.
 It should only be done prior
to
termination of pregnancy in

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 the operation theatre
under anaesthesia.

4. 5 min. Diagnosis of Diagnosis: L Black

placenta I. PLACENTOGRAPHY: E board List down the
previa  SONOGRAPHY C diagnosis of
• Trans abdominal ultrasound T placenta previa?
• Trans vaginal ultrasound U
• Trans perineal ultrasound R
 MRI E
. CLINICAL CONFIRMATION C
 By internal examination U
 Direct visualization during
M
caesserean section
D
 Examination of the placenta
I
following vaginal delivery
S

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 Complications: C
5. 10 Complication MATERNAL: (during pregnancy) U Black
min. of placenta  Antepartum haemmorhage S board Enemurate
previa. with varying degrees of shock S complication of
 Malpresentation I placenta previa?
 Premature labour O
During labour: N
 Early rupture of the membranes L
 cord prolapse E
 Slow dilatation of the cervix C
 Intrapartum haemmorhage T
 Increased incidence of operative U
interference R
 Postpartum haemorrhage
E
 Retained placenta
C
Puerperium:
U
 Sepsis
M

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  Subinvolution D
 Embolism I
FETAL: S
Low birth weight, asphyxia, C
intrauterine death, birth injuries, U
congenital malformations S
Management: S
6. 15 Medical PREVENTION: I Black
min. management  Adequate antanatal care O board Explain the medical
of placenta  Antanatal diagnosis N management of
previa of low lying placenta L placenta previa?
at 20 th weeks with E
routine
C
ultrasonography
T
 Significance of “warning
U
haemorrhage”
R
 Family planning and limitation
E

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of birth reduce the incidence C
of placenta praevia. U
INTERVENTION: M
An initial assessment to determine the D
status of the mother and fetus is I
required. Although mothers used to be S
treated in the hospital from the first C
bleeding episode until birth, it is now U
considered safe to treat placenta S
praevia on an outpatient basis if the S
fetus is at less than 30 weeks of I
gestation, and neither the mother nor O
the fetus are in distress.
N
Immediate delivery of the fetus may
be indicated if the fetus is mature or if
L
the fetus or mother are in distress.
E
Blood volume replacement (to maintain
C

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blood pressure) and blood T
plasma replacement (to maintain U
fibrinogen levels) may be necessary. R
It is controversial if vaginal delivery E
or a Caesarean section is the safest C
method of delivery. In cases of fetal U
distress a Caesarean section is M
indicated. Caesarian section is D
contraindicated in cases of I
disseminated intravascular S
coagulation. C
A problem exists in places where a U
Caesarean section cannot be
S
performed, due to the lack of a
S
surgeon or equipment. In these cases
I
the infant can be delivered vaginally.
O
There are two ways of doing this with
N

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a placenta praevia: L
 The baby's head can be brought E
down to the placental site (if C
necessary with Willet's forceps T
or a vulsellum) and a weight U
attached to his scalp A leg can be brought R
down and E
the baby's buttocks used to C
compress the placental site U
The goal of this type of delivery is to M
save the mother, and both methods D
will often kill the baby. These I
methods were used for many years
S
before Caesarean section and saved
C
the lives of both mothers and babies
U
with this condition.
S
The main risk with a vaginal delivery
S

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with a praevia is that as you are trying I
to bring down the head or a leg, you O
might separate more of the placenta N
and increase the bleeding.
Placenta praevia increases the risk of
puerperal sepsis and postpartum
haemorrhage because the lower
segment to which the placenta was
attached contracts less
well postdelivery.

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SUMMARY:
when the placenta is implanted partially or Completely over the lower uterine segment it is called as
placenta praevia. Predisposing factors like Multiparity, Increased maternal age, H/o Caesarian section, smoking .
If bleeding takes place, it is essential to obtain immediate care in a hospital Emergency Room. There are two
standard courses of treatment: immediate delivery by cesarean or "expectant management" strict, in-hospital
bedrest and frequent monitoring until the baby is mature enough to live without a respirator outside the uterus.
CONCLUSION:
At the end of the class the student have gain knowledge about definition, etiology, clinical features, diagnosis,
complications, medical management of placenta praevia.

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 BIBLIOGRAPHY :
 Myles. “Text book for midwives”.7 edition 2004; Churchill living stone. Page no – 178-180
th

 D.C. Dutta. Text book of Obstetrics. 6th edition 2004; New central book agency.
 D.C. Dutta. Text book of Obstetrics. 6th edition 2004; New central book agency.

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