The term placenta praevia is used when placenta lies _____
Answer
Directly over the internal os.
Question 2
The term low – lying placenta should be used for placental edge less than ___ from the internal os.
Answer
20 mm
Question 3
The term low – lying placenta should be used for placental edge less than 20 mm from the internal os for pregnancies more than ___
Answer
16 weeks
Question 4
Follow up ultrasound after detection of low – lying placenta at anomaly scan is done at ____weeks of gestation
Answer
32 weeks (including a TVS)
Question 5
For persistent low – lying placenta or placena praevia at 32 weeks, additional TVS done at _____.
Answer
36 weeks
Question 6
Role of cervical length measurement in asymptomatic women with placenta praevia
Answer
Is to facilitate management decisions (short cervix on TVS before 34 weeks -↑ risk of preterm emerg delivery and massive h’age at caesarean section)
Question 7
The use of cervical cerclage to reduce bleeding and prolong pregnancy with placenta praevia
Answer
Is not supported outside clinical trial
Question 8
Recommendation regarding antenatal corticosteroid therapy with low-lying placenta or placenta praevia
Answer
Single dose recommended between 34+0 and 35+6 weeksÂ
Question 9
Role of tocolysis with symptomatic placenta praevia
Answer
Considered for 48 hours to facilitate administeration of antenatal steroids
Question 10
For uncomplicated placenta praevia, when should delivery be timed?
Answer
Between 36+0 and 37+0 weeks of gestation
Question 11
When should delivery be timed for placenta praevia with hisory of vaginal bleeding or risk factors for preterm delivery?
Answer
Between 34+0 and 36+6 weeks of gestation
Question 12
Which anaesthesia is most appropriate for women with placenta praevia or low-lying placenta?Â
Answer
Regional anaesthesia – safe. Counselling that GA may be needed.
Question 13
Surgical approach if fetus is in trasverse lie, below 28 weeks gestation.
Answer
Vertical skin and/or uterine incisions
Question 14
Major risk factors for placenta accreta spectrum
Answer
History of accreta in prev pregnancy, Prev CS/uterine surgery, Repeated endometrial currettage
Question 15
Role of MRI in diagnosis of accreta spectrum?
Answer
To complement USS esp with posterior placenta &/or parametrial invasion.
Question 16
When should women be screened for placenta accreta?Â
Answer
H/o prev CS + anterior low-lying placenta or praevia on anomaly scan
Question 17
Timing of delivery for placenta accreta without other risk factors
Answer
Between 35+0 and 36+6 weeks
Question 18
Anaesthesia for women with placenta accreta
Answer
Regional anaesthesia – safe. Counselling that GA may be needed.
Question 19
Surgical approach for women with placenta accreta
Answer
Caesarean section hysterectomy with placenta left in situ
Question 20
When is uterus preserving surgery/partial myometrial resection with placenta accreta appropriate?Â
Answer
Extent limited in depth and surface area, entire placental area accessible and visualised
Question 21
Placenta accreta locations when uterus preserving surgery is suitable.
Answer
Completely anterior, fundal or posterior without deep pelvic invasion.
Question 22
Role of ureteric stents with placenta accreta spectrum
Answer
When urinary bladder is invaded by placental tissue
Question 23
If uterine preservation desired with placenta accreta
Answer
Consider leaving placenta in situ.
Question 24
Follow up if placenta left in situ
Answer
Regular review, USS and emergency access (if bleeding or infection).
Question 25
Should Methotrexate be used for expectant management with placenta in situ?
Answer
NOT to be used as unproven benefit and significant adverse effects
Question 26
Role of interventional radiology with acccreta
Answer
When declining blood transfusion.
Question 27
Management of undiagnosed placenta accreta at elective repeat CS
Answer
Delay surgery – close abdomen + transfer to specialist unit.Â
Question 28
Unsuspected placenta accreta diagnosed after birth of baby
Answer
Leave placenta in situ, perform emergency hysterectomy.
Question 29
Incidence of placenta praevia at term
Answer
1 in 200 pregnancies
Question 30
Placenta accreta was first defined in 1937 by
Answer
Irving and Hertig
Question 31
Placenta ‘creta’ or ‘adherenta’ is in whichÂ
Answer
Villi adhere superficially to the myometrium without interposing decidua
Question 32
Placenta ‘increta’ is in whichÂ
Answer
Villi penetrate deeply into the uterine myometrium down to the serosa.
Question 33
Placenta ‘percreta’ is in which
Answer
Villi perforate through the entire uterine wall & may invade the surrounding pelvic organs, such as bladder.
Question 34
Prevalence of placenta accreta in range of
Answer
Between 1 in 300 to 1 in 2000 pregnancies
Question 35
Risk factors for placenta praevia
Answer
CS (risk rises as number of CS increases)
ART
Smoking
Question 36
High risk of emergency transfusion + no clinically significant alloantibodies….how frequently should group and screen samples be sent?
Answer
Once a week (to exclude or identify any new antibody formation)
Question 37
Risk of accreta placentation after 1 CS is
Answer
3%
Question 38
Risk of accreta placentation after 2 CS is
Answer
11%
Question 39
Risk of accreta placentation after 3 CS is
Answer
40%
Question 40
Risk of accreta placentation after 4 CS is
Answer
61 %
Question 41
Risk of accreta placentation after 5 CS is
Answer
67 %
Question 42
Risk of accreta placentation after 6 CS is
Answer
67 % (for 5 or more CS)
Question 43
Incidence of massive haemorrhage in placenta praevia
Answer
21%
Question 44
Increase in risk of placenta praevia after IVF as compared to natural pregnanciesÂ
