Incidencia de placenta previa en el Hospital Gineco-Obstétrico Enrique C. Sotomayor en el año 2014
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2015
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Universidad de Guayaquil. Facultad de Ciencias Mèdicas. Escuela de Medicina
Resumen
La placenta previa es la implantación de la placenta en el segmento uterino inferior, recubriendo el cérvix o cerca de él, pudiendo llegar a anteponerse totalmente a la presentación fetal, y es una de las causas más frecuentes de sangrado en el tercer trimestre de embarazo. Su frecuencia oscila entre 1 / 125 a 1 / 300 nacimientos. Se aceptan cuatro formas básicas de placenta previa: placenta previa total (tipo I): el orificio cervico-uterino está cubierto por completo por la placenta: placenta previa parcial (tipoII): la placenta cubre parcialmente el orificio interno; placenta previa marginal (III): la placenta llega justamente al margen del orificio interno; placenta previa lateral o de inserción baja –implantación baja de la placenta- (tipoIV): la placenta está implantada en el segmento uterino de modo que el borde de la placenta, en realidad no llega al orificio interno, pero se encuentra en estrecha proximidad al mismo.
La frecuencia de la placenta previa aumenta con la parida, con la edad, con el antecedente de placenta previa y con la presencia de cesáreas previas. Las causas pueden ser ovulares o endometriales.
La clínica más frecuente es la hemorragia indolora brusca, de sangre roja y brillante, variable en cantidad, en el segundo o tercer trimestre de la gestación. La ausencia de contracciones uterinas es el dato más importante para establecer el diagnóstico diferencial con el Abruptio Placentae aunque en el 10% de los casos puede existir concomitancia de ambos cuadros. El diagnostico se realizara básicamente mediante la ecografía que evidencia su presencia.
El tratamiento de la placenta previa busca evitar la muerte materna y reducir la elevada mortalidad perinatal. La mortalidad materna ha descendido a menos del 1% en la última década, y la perinatal ha descendido del 60% al 70% a menos del 10%. El tratamiento implica en la mayoría de ocasiones la realización de una cesárea.
Placenta previa is implantation of the placenta in the lower uterine segment, covering the cervix or near it, being able to fully take precedence fetal presentation, and is one of the most common causes of bleeding in the third trimester. Its frequency varies between 1/125 1/300 births. Total placenta previa (type I): four basic forms of placenta previa accepted cervical-uterine hole is covered completely by the placenta previa partial (tipoII): the placenta partially covers the internal os; marginal placenta previa (III): the placenta comes just outside the inner bore; low side or low insertion -Implementation of the placenta (tipoIV) placenta previa: the placenta is implanted in the uterine segment so that the edge of the placenta, actually does not reach the internal os, but is in close proximity to same. The frequency of placenta previa increases with calving, with age, with a history of placenta previa and the presence of previous cesarean sections. The causes may be ovular or endometrial. The most frequent clinic is the sudden painless bleeding, bright red blood, varying in quantity, in the second or third trimester. The absence of uterine contractions is the most important thing for differential diagnosis with placental abruption but in 10% of cases may be coincidence of both boxes. The diagnosis will be made mainly through ultrasound that shows its presence. Treatment of placenta previa seeks to prevent maternal death and reduce the high perinatal mortality. Maternal mortality has fallen to less than 1% in the last decade, and the perinatal has fallen from 60% to 70% to less than 10%. Treatment involves in most cases performing a cesarean.
Placenta previa is implantation of the placenta in the lower uterine segment, covering the cervix or near it, being able to fully take precedence fetal presentation, and is one of the most common causes of bleeding in the third trimester. Its frequency varies between 1/125 1/300 births. Total placenta previa (type I): four basic forms of placenta previa accepted cervical-uterine hole is covered completely by the placenta previa partial (tipoII): the placenta partially covers the internal os; marginal placenta previa (III): the placenta comes just outside the inner bore; low side or low insertion -Implementation of the placenta (tipoIV) placenta previa: the placenta is implanted in the uterine segment so that the edge of the placenta, actually does not reach the internal os, but is in close proximity to same. The frequency of placenta previa increases with calving, with age, with a history of placenta previa and the presence of previous cesarean sections. The causes may be ovular or endometrial. The most frequent clinic is the sudden painless bleeding, bright red blood, varying in quantity, in the second or third trimester. The absence of uterine contractions is the most important thing for differential diagnosis with placental abruption but in 10% of cases may be coincidence of both boxes. The diagnosis will be made mainly through ultrasound that shows its presence. Treatment of placenta previa seeks to prevent maternal death and reduce the high perinatal mortality. Maternal mortality has fallen to less than 1% in the last decade, and the perinatal has fallen from 60% to 70% to less than 10%. Treatment involves in most cases performing a cesarean.
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Placenta previa, Incidencia, Hospital Gineco-Obstétrico Enrique C. Sotomayor, Cantón Guayaquil, Ecuador