In the context of precocious pregnancy, flawed implantation of the placenta is possible. This can remain asymptomatic in the beginning. However, bleedings mostly occurs in the end of pregnancy for the first time. Also, vaginal bleedings can be the cause of premature placenta detachment. These bleedings are life threatening for mother and child, and are very painful. In the following, these clinical pictures are further described considering differential diagnoses.  

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placenta previa

Image: “Placenta previa” by OpenStax College. License: CC BY 3.0

Placenta Praevia

Definition of Placenta Praevia

Placenta praevia means the dystopic position of the placenta in the isthmus region. Roughly 10 out of 200 pregnancies are affected by this condition.

Etiology of Placenta Praevia

Lesions of the endometrium can be the cause for placenta praevia. Amongst others, a curettage, condition after a section or after pregnancy with multiples can lead to these lesions.

Clinic of Placenta Praevia

By means of uterus contraction, the lower uterine segment is stretched. This shears the placenta away from the adhesion surface and bleeding occurs.

Typically, the first bleedings are observed in the 3rd trimenon. Initially, those are bleedings out of the intravillous region. This means that it is maternal blood. Later, it can also be fetal blood. Thus, controls of the blood for HbF are indicated.

Diagnostics of Placenta Praevia

placenta previa x-ray

Image: “Anterior placenta previa. The placenta (arrow) has covered the internal os completely (arrowhead)” by Openi. License: CC BY 2.0

Diagnosis of placenta praevia is secured with ultrasound examination. The pregnant woman is then hospitalized and strict bed rest is indicated.

Note: At presence of these symptoms, vaginal palpation examination is strictly contraindicated.

Therapy of Placenta Praevia

In exceptional cases, a vaginal birth attempt can be made. In most cases, however, a Caesarean section should be considered. In case of small bleedings before the 34th week of pregnancy, tocolysis should be performed and then a Caesarean section should be planned.

Premature Placenta Detachment

Definition of Premature Placenta Detachment

placenta detachment

Image: “Placental Abruption” by BruceBlaus. License: CC BY 3.0

This corresponds to a complete or partial detachment of the placenta before birth of the child. This situation represents a dramatic emergency for mother and child.

Pathogenesis of Premature Placenta Detachment

Often, hypertensive pregnancy diseases or uterus abnormalities lead to premature detachment of the placenta. Due to these diseases, bleedings out of the uterine vessels can occur. Thus, a retroplacentary hematoma develops, which leads to the detachment of the placenta.

Clinic of Premature Placenta Detachment

Usually, sudden severe abdominal pain is described. Additionally, vaginal bleeding and a continuously contracted uterus is present. This high-acute situation threatens the child due to an insufficient supply with oxygen. Usually, acute hypoxia results. The severe blood loss endangers the mother. Also, an amniotic fluid embolism can occur with an acute coagulation disorder.

Diagnostics of Premature Placenta Detachment

In clinical examination, the uterus is very rigid and very pressure-sensitive. The movements of the child decrease due to hypoxia and CTG becomes pathological.

Therapy of Premature Placenta Detachment

Only an emergency C-section can save the child’s life.

Popular Exam Questions on Premature Placenta Detachment and Placenta Praevia

1. A pregnant woman I the 25th + 3 week of pregnancy presents with suddenly occurring pain and vaginal bleedings. Which is the most likely diagnosis?

  1. Placenta praevia
  2. Placenta insufficiency
  3. Premature placenta detachment
  4. Sigma diverticulitis
  5. Appendicitis

2. Which therapy is the right choice in the mentioned case?

  1. Caeserean section
  2. Spontaneous birth
  3. Treatment with metoprolol
  4. Vacuum extraction
  5. Water birth

3. Which is the leading symptom of placenta praevia?

  1. Pressure-sensitive vaginal bleeding
  2. Growth retardation of the child
  3. Dystrophic fetus
  4. Painless vaginal bleeding
  5. Decreased amount of amniotic fluid
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