Velamentous Cord Insertion and Vasa Previa
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Placenta Praevia/Low-Lying Placenta
LOCAL OPERATING PROCEDURE – CLINICAL Approved Quality & Patient Safety Committee 18/6/20 Review June 2022 PLACENTA PRAEVIA/LOW-LYING PLACENTA This LOP is developed to guide clinical practice at the Royal Hospital for Women. Individual patient circumstances may mean that practice diverges from this LOP. 1. AIM • Diagnosis and clinical management of woman with low-lying placenta (LLP) or placenta praevia (PP) 2. PATIENT • Pregnant woman with a LLP/PP after 20 weeks gestation 3. STAFF • Medical and midwifery staff 4. EQUIPMENT • Ultrasound • 16-gauge intravenous (IV) cannula • Blood tubes 5. CLINICAL PRACTICE Screening: • Recommend a morphology ultrasound at 18-20 weeks gestation to ascertain placental location • Include, on the ultrasound request form, any history of uterine surgery e.g. previous caesarean section (CS), myomectomy, to ensure that features of placenta accreta are examined • Identify woman with a: o LLP i.e. within 2cm of, but not covering the internal cervical os o PP i.e. covering the internal cervical os Antenatal care: • Reassure woman that 9 out of 10 LLP found at 18-20 week morphology ultrasound are no longer low-lying by term1 • Reassure woman with LLP that if she remains asymptomatic, there is no increased risk of adverse outcomes in the mid-trimester and she can continue normal activities e.g. travel, intercourse, exercise2 • Advise woman with LLP from 36 weeks that it is not a contraindication for trial of labour, chance of vaginal birth approximately9: o 43% if placenta is 0-10mm from cervical os o 85% if placenta -
Cohort Study of High Maternal Body Mass Index and the Risk of Adverse Pregnancy and Delivery Outcomes in Scotland
Open access Original research BMJ Open: first published as 10.1136/bmjopen-2018-026168 on 20 February 2020. Downloaded from Cohort study of high maternal body mass index and the risk of adverse pregnancy and delivery outcomes in Scotland Lawrence Doi ,1 Andrew James Williams ,2 Louise Marryat ,3,4 John Frank3,5 To cite: Doi L, Williams AJ, ABSTRACT Strengths and limitations of this study Marryat L, et al. Cohort Objective To examine the association between high study of high maternal maternal weight status and complications during pregnancy ► This study used a large, retrospectively accessed body mass index and the and delivery. risk of adverse pregnancy but cohort- structured, national database covering Setting Scotland. and delivery outcomes some of the major maternal and neonatal outcomes Participants Data from 132 899 first- time singleton in Scotland. BMJ Open in Scotland over eight recent years. deliveries in Scotland between 2008 and 2015 were used. 2020;10:e026168. doi:10.1136/ ► Analyses were adjusted for some of the key potential Women with overweight and obesity were compared with bmjopen-2018-026168 confounders to estimate impact of high maternal- women with normal weight. Associations between maternal ► Prepublication history and weight status on each outcome. body mass index and complications during pregnancy and 2 additional material for this ► All women with body mass index (BMI) of 30 kg/m delivery were evaluated. paper are available online. To or more were considered as having obesity; it is like- Outcome measures Gestational diabetes, gestational view these files, please visit ly that differentiating morbid obesity or obesity class hypertension, pre- eclampsia, placenta praevia, placental the journal online (http:// dx. -
Umbilical Cord Prolapse Guideline
Umbilical Cord Prolapse Guideline Document Control Title Umbilical Cord Prolapse Guideline Author Author’s job title Specialty Trainee in Obstetrics and Gynaecology Directorate Department Women’s and Children’s Obstetrics and Gynaecology Date Version Status Comment / Changes / Approval Issued 1.0 Mar Final Approved by the Maternity Services Guideline Group in 2011 April 2011. 1.1 Aug Revision Minor amendments by Corporate Governance to 2012 document control report, headers and footers, new table of contents, formatting for document map navigation. 2.0 Feb Final Approved by the Maternity Services Guideline Group in 2016 February 2016. 2.1 Apr Revision Harmonised with Royal Devon & Exeter guideline 2019 3.0 May Final Approved by Maternity Specialist Governance Forum 2019 meeting on 01.05.2019 Main Contact ST1 O&G Tel: Direct Dial– 01271 311806 North Devon District Hospital Raleigh Park Barnstaple Devon EX31 4JB Lead Director Medical Director Superseded Documents Nil Issue Date Review Date Review Cycle May 2019 May 2022 Three years Consulted with the following stakeholders: (list all) Senior obstetricians Senior midwives Senior management team Filename Umbilical Cord Prolapse Guideline v3. 01May 19.doc Policy categories for Trust’s internal Tags for Trust’s internal website (Bob) website (Bob) Cord, accidents, prolapse Maternity Services Maternity Page 1 of 11 Umbilical Cord Prolapse Guideline CONTENTS Document Control .................................................................................................... 1 1. Introduction -
Low-Lying Placenta
LOW- LYING PLACENTA LOW-LYING PLACENTA WHAT IS PLACENTA PRAEVIA? The placenta develops along with the baby in the uterus (womb) during pregnancy. It connects the baby with the mother’s blood system and provides the baby with its source of oxygen and nourishment. The placenta is delivered after the baby and is also called the afterbirth. In some women the placenta attaches low in the uterus and may be near, or cover a part, or lie over the cervix (entrance to the womb). If it is shown in early ultrasound scans, it is called a low-lying placenta. In most cases, the placenta moves upwards as the uterus enlarges. For some women the placenta continues to lie in the lower part of the uterus in the last months of pregnancy. This condition is known as placenta praevia. If the placenta covers the cervix, this is known as major placenta praevia. Normal Placenta Placenta Praevia Major Placenta Praevia WHAT ARE THE RISKS TO MY BABY AND ME? When the placenta is in the lower part of the womb, there is a risk that you may bleed in the second half of pregnancy. Bleeding from placenta praevia can be heavy, and so put the life of the mother and baby at risk. However, deaths from placenta praevia are rare. You are more likely to need a caesarean section because the placenta is in the way of your baby being born. HOW IS PLACENTA PRAEVIA DIAGNOSED? A low-lying placenta may be suspected during the routine 20-week ultrasound scan. Most women who have a low-lying placenta at the routine 20-week scan will not go on to have a low-lying placenta later in the pregnancy – only 1 in 10 go on to have a placenta praevia. -
A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction .............................................................................................................. -
A Case of Posterior Placenta Previa in an in Vitro Fertilization Pregnancy Complicated by Velamentous Cord Insertion
Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 2020 Uterine Sandwich Method: A Case of Posterior Placenta Previa in an In Vitro Fertilization Pregnancy Complicated by Velamentous Cord Insertion Martin Castaneda Bethesda Hospital East Follow this and additional works at: https://scholarlycommons.baptisthealth.net/se-all-publications Citation Cureus (2020) 12(6):e8525 This Article -- Open Access is brought to you for free and open access by Scholarly Commons @ Baptist Health South Florida. It has been accepted for inclusion in All Publications by an authorized administrator of Scholarly Commons @ Baptist Health South Florida. For more information, please contact [email protected]. Open Access Case Report DOI: 10.7759/cureus.8525 Uterine Sandwich Method: A Case of Posterior Placenta Previa in an In Vitro Fertilization Pregnancy Complicated by Velamentous Cord Insertion Joseph Farshchian 1 , Martin Castaneda 2 1. Surgery, Florida Atlantic University College of Medicine, Boca Raton, USA 2. Obstetrics and Gynaecology, Bethesda Hospital East, Boynton Beach, USA Corresponding author: Joseph Farshchian, [email protected] Abstract The risk of postpartum hemorrhage (PPH) and placental adhesion anomalies, including placenta previa, may be increased in pregnancies conceived by in vitro fertilization (IVF) and other forms of assisted reproduction technologies. The uterine compression suture, known as the “uterine sandwich method,” may be useful in pregnancies complicated by placenta previa. We report an unusual case of placenta previa complicated by velamentous cord insertion, which was treated by a B-Lynch suture, a Bakri balloon tamponade, and vaginal packing. Categories: Obstetrics/Gynecology, Miscellaneous, Quality Improvement Keywords: obstetrics, gynaecology, postpartum hemorrhage, uterine sandwich, b-lynch suture Introduction Placenta previa is a complication of placental adhesion to the uterine wall, where placental tissue extends over the internal cervical os. -
A Risk Model to Predict Severe Postpartum Hemorrhage in Patients with Placenta Previa: a Single-Center Retrospective Study
621 Original Article A risk model to predict severe postpartum hemorrhage in patients with placenta previa: a single-center retrospective study Cheng Chen, Xiaoyan Liu, Dan Chen, Song Huang, Xiaoli Yan, Heying Liu, Qing Chang, Zhiqing Liang Department of Gynecology and Obstetrics, the First Affiliated Hospital, Army, Military Medical University, Chongqing 400038, China Contributions: (I) Conception and design: C Chen, Q Chang, Z Liang; (II) Administrative support: Q Chang; (III) Provision of study materials: C Chen, X Liu, D Chen; (IV) Collection and assembly of data: C Chen, S Huang, X Yan, H Liu; (V) Data analysis and interpretation: C Chen; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Qing Chang; Zhiqing Liang. Department of Gynecology and Obstetrics, the First Affiliated Hospital, Army, Military Medical University, Chongqing 400038, China. Email: [email protected]; [email protected]. Background: The study aimed to establish a predictive risk model for severe postpartum hemorrhage in placenta previa using clinical and placental ultrasound imaging performed prior to delivery. Methods: Postpartum hemorrhage patients were retrospectively enrolled. Severe postpartum hemorrhage was defined as exceeding 1,500 mL. Data collected included clinical and placental ultrasound images. Results: Age of pregnancy, time of delivery, time of miscarriage, history of vaginal delivery, gestational weeks at pregnancy termination, depth of placenta invading the uterine muscle wall were independent -
Antepartum Haemorrhage
OBSTETRICS AND GYNAECOLOGY CLINICAL PRACTICE GUIDELINE Antepartum haemorrhage Scope (Staff): WNHS Obstetrics and Gynaecology Directorate staff Scope (Area): Obstetrics and Gynaecology Directorate clinical areas at KEMH, OPH and home visiting (e.g. Community Midwifery Program) This document should be read in conjunction with this Disclaimer Contents Initial management: MFAU APH QRG ................................................. 2 Subsequent management of APH: QRG ............................................. 5 Management of an APH ........................................................................ 7 Key points ............................................................................................................... 7 Background information .......................................................................................... 7 Causes of APH ....................................................................................................... 7 Defining the severity of an APH .............................................................................. 8 Initial assessment ................................................................................................... 8 Emergency management ........................................................................................ 9 Maternal well-being ................................................................................................. 9 History taking ....................................................................................................... -
Recode - Guidelines for Use the System Is Hierarchical I.E
ReCoDe - Guidelines for use The system is hierarchical i.e. categories at the head of the list take priority over those lower down. However multiple relevant conditions can be recorded. The primary condition is the highest on the list that is applicable to the case. Secondary condition is the next relevant condition down the list e.g. for codes B2, F3, and A7 - the primary code is A7, secondary code is B2 etc. ReCoDe - version 2.0 Group Condition further definition inclusion/exclusion A Fetus A1 Lethal congenital anomaly Lethal or severe. Any structural, genetic, or metabolic defect arising at conception or during embryogenesis incompatible with life or potentially treatable but causing death. A2 Infection Positive fetal microbiologic or serological culture. 2.1 Chronic – e.g. TORCH E.g. congenital or intrauterine pneumonia, cytomegalovirus, 2.2 Acute rubella, herpes. A3 Non-immune hydrops fetalis Presence of any two of the following signs: Ascites pericardial effusion pleural effusion subcutaneous oedema. A4 Iso-immunisation Blood group incompatibility rhesus or non rhesus (ABO). Death ascribable to blood group incompatibility. An indirect Coomb test greater than 1/16 and fetal hydrops (see A3). A5 Fetomaternal haemorrhage Haemorrhage into maternal circulation Kleihauer-Betke test > 0.4%1. A6 Twin-twin transfusion Presence of polyhydramnios (maximum vertical pocket of ≥ 8 cm) and oligohydramnios (maximum vertical pocket of ≤ 2 cm)2. A7 Fetal growth restriction SGA by customised percentile, intrauterine growth retardation. < 10th customised weight for gestational age centile3 OR IUGR reported on clinical or pathological grounds. A8 Other fetus Death due to other specific fetal conditions e.g. -
Preterm Birth Due to Cervical Insufficiency Complicated by Placenta Accreta and Postpartum Haemorrhage Managed by Uterine Artery Embolisation
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Tetere E et al. Int J Reprod Contracept Obstet Gynecol. 2014 Sep;3(3):746-748 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: 10.5455/2320-1770.ijrcog20140975 Case Report Preterm birth due to cervical insufficiency complicated by placenta accreta and postpartum haemorrhage managed by uterine artery embolisation Elina Tetere1*, Anna Jekabsone1, Ieva Kalere1, Dace Matule2 1Department of Obstetrics & Gynaecology, Riga Stradins University, Riga, Latvia 2Department of Gynaecology, ARS Medical Company, Riga, Latvia Received: 5 August 2014 Accepted: 19 August 2014 *Correspondence: Dr. Elina Tetere, E-mail: [email protected] © 2014 Tetere E et al. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT In this report, we present the case of a young woman undergoing her second pregnancy, with early detected shortened cervix resulting in cervical cerclage procedure. At gestational week 24/25, she presented at a hospital with signs of intra-amniotic infection and spontaneous rupture of membranes. This resulted in pathological preterm delivery with massive postpartum bleeding, which was managed by bilateral uterine artery embolization. Reasons for preterm birth and management options are discussed. Keywords: Preterm birth, Cervical cerclage, Placenta accreta, Uterine artery embolization INTRODUCTION CASE REPORT Preterm birth (PTB) is a severe pregnancy outcome, A 27-year-old woman presented with her second which is associated with high morbidity and mortality of pregnancy. In 2009, she had a vaginal term delivery the new-born; therefore, it is important to identify the risk which was complicated by PPH due to placental factors involved. -
Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo
Open Access Austin Journal of Pregnancy & Child Birth Research Article Risk Factors and Outcomes of Placenta Praevia in Lubumbashi, Democratic Republic of Congo Ndomba MM1, Mukuku O2*, Tamubango HK2, Biayi JM1, Kinenkinda X1, Kakudji PL1 and Abstract 1 Kakoma JB Introduction: Placenta Praevia (PP) is frequently associated with severe 1Department of Gynecology and Obstetrics, University of maternal bleeding leading to an increased risk for adverse outcome of mother Lubumbashi, Democratic Republic of Congo and infant. This study aims to determine the prevalence, and to evaluate potential 2Higher Institute of Medical Techniques, Democratic risk factors and respective outcomes of pregnancies with PP in Lubumbashi, Republic of Congo Democratic Republic of Congo. *Corresponding author: Olivier Mukuku, Higher Methods: Data were retrospectively collected from patients diagnosed Institute of Medical Techniques, Lubumbashi, with PP at 4 hospitals in Lubumbashi between January 2013 and December Democratic Republic of Congo 2016. All women who gave birth to singleton infants were studied. Differences Received: January 11, 2021; Accepted: February 02, between women with PP and without PP were evaluated. Adjusted Odds Ratios 2021; Published: February 09, 2021 (aOR) with 95% confidence intervals for risk factors, and adverse maternal and perinatal outcomes associated with PP were estimated in multivariable logistic regression. Results: The overall prevalence of PP was 1.49% (227/15,292). The following risk factors were independently associated with PP: multiparity ≥6 (aOR=2.36; 95% CI: 1.13-4.91), previous cesarean section (aOR=6.74; 95% CI: 2.99-15.18), and no antenatal care visit during pregnancy (aOR=7.15; 95% CI: 4.86-10.53). -
Umbilical Cord Accidents
UMBILICAL CORD ACCIDENTS DR PADMASRI R PROF & HOD, DEPT OF OBSTETRICS & GYNAECOLOGY SAPTHAGIRI INSTITUTE OF MEDICAL SCIENCES 1 • “Cord accident,” defined by obstruction of fetal blood flow through the umbilical cord, is a common ante- or perinatal occurrence. • Obstruction can be either acute, as in cases of cord prolapse during delivery, or sub acute to-chronic, as in cases of grossly abnormal umbilical cords Placental findings in cord accidents. Mana M Parast From Stillbirth Summit 2011, Minneapolis, USA 2 TYPES Acute events Sub Acute on Chronic • Umbilical Cord Prolapse • Loops • Knots • Vasa Praevia • Entanglements • Coiling • Torsion • Rupture • Haematomas, thrombosis • Cysts, tumours • Nuchal Cord • Insertion - velamentous cord CORD COMPRESSION – SUDDEN IUD’s 3 CORD COMPRESSION 2 Principles of asphyxia are: a. Cord compression -preventing venous return to the fetus b. Umbilical vasospasm -preventing venous and arterial blood flow to and from the fetus due to exposure to external environment. 4 Recovery time from compression • 1min, 1 time 100% compression – 5 mins to recover- oxygen levels decrease by 50% • 5 mins comp – 30 mins to recover • Continued 5 min compressions every 30 mins causes fetal decompensation RISK FACTORS FOR CORD PROLAPSE GENERAL PROCEDURE RELATED Artificial rupture of membranes with high Multiparity presenting part Vaginal manipulation of the fetus with ruptured Low birthweight (< 2.5 kg) membranes Preterm labour (< 37+0 External cephalic version (during procedure) weeks) Fetal congenital anomalies Internal podalic version Breech presentation Stabilising induction of labour Transverse, oblique and Insertion of intrauterine pressure transducer unstable lie* Second twin Large balloon catheter induction of labour Polyhydramnios Unengaged presenting part Low-lying placenta RCOG Green-top Guideline No.