AUTOR: JORGE ANDRÉS CASTRO FLORES
PATOLOGIA PLACENTARIA
NO HACER TACTO VAGINAL EN SOSPECHA DE PLACENTA PREVIA O DESPRENDIMIENTO DE PLACENTA
ANTE FACTORES DE RIESGO COMO CICATRIZ UTERINA PREVIA + PLACENTA PREVIA= SOSPECHAR ACRETISMO
PLACENTA PREVIA
DEFINICIÓN. Se define como la inserción de la placenta en el segmento inferior del utero.
ES LA PRINCIPAL CAUSA DE HEMORRAGIA EN EL TERCER TRIMESTRE DEL EMBARAZO.
FACTORES DE RIESGO DE LA PLACENTA PREVIA
CICATRICES UTERINAS POR CESÁREAS PREVIAS
MULTIPARIDAD
EDAD AVANZADA
EMBARAZO MÚLTIPLE
TABAQUISMO ACTIVO O USO DE COCAINA
TÉCNICAS DE REPRODUCIÓN ASISTIDA
CLASIFICACIÓN.
PLACENTA INSERCIÓN BAJA Borde placentario se encuentra en el segmento inferior a menos de 7cm del OCI.
PP CENTRAL PARCIAL Placenta cubre el OCI solamente cuando el cuello se encuentra cerrado pero cuando
hay una dilatación igual o mayor >3cm solo cubre parcialmente el OCI.
PP CENTRAL TOTAL Placenta cubre la TOTALIDAD del OCI aun con dilatación avanzada.
PLACENTA PREVIA
El borde de la placenta alcanza los márgenes del OCI
MARGINAL
With any degree of placenta previa, a certain amount
of spontaneous placental separation is inevitable
during lower uterine segment remodeling and
cervical dilation.
La CICATRIZ UTERINA ANTERIOR y LA
PRESENCIA de PLACENTA PREVIA son de
ALTO RIESGO para desarrollar un
ACRETISMO PLACENTARIO EN UN 60%
DEBIDO A LA POBRE DECIDUALIZACIÓN
, AUTOR: JORGE ANDRÉS CASTRO FLORES
LA PLACENTA PREVIA PUEDE VERSE DE MANERA PRENATAL, SI PARA LA SEMANA 28 SIGUE PREVIA, SERÁ PREVIA
CONFIRMANDO DIAGNOSTICO USG A LAS 32 SEMANAS
DIAGNÓSTICO DE PLACENTA PREVIA
NO EXISTE AFECTACION
SANGRADO HEMORRAGIA INDOLORA
SANGRE ROJO BRILLANTE FETAL A MENOS QUE HAYA
CENTINELA PREVIO ROJA ABUNDANTE
HIPOVOLEMIA MATERNA
ULTRASONIDO ENDOVAGINAL ES EL MÉTODO DIAGNÓSTICO DE ELECCIÓN YA QUE LOCALIZA LA PLACENTA Y LA
ESTÁTICA FETAL.
A cervical digital examination is done with the woman in an operating room and with preparations or immediate cesarean
delivery. Even the gentlest examination can cause torrential hemorrhage.
SE ESTIMA UN SANGRADO INTRAOPERATORIO DE 2000 A 5000ml CON RIESGO TRANSFUSION EN UN 40 A 90%
TRATAMIENTO DE PLACENTA PREVIA
APLICAR ESQUEMA DE MADURACIÓN PULMONAR 24-34SDG Y TOCOLITICOS PARA COMPLETAR EL ESQUEMA
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