1.

Definisi
Placenta pre´via low implantation of the placenta so that it partially or completely covers
the cervical os. It is the most common cause of painless bleeding in the third trimester of
pregnancy.
plasenta pre'via adalah plasenta yang tempatnya rendah sehingga sebagian atau seluruhnya
menutupi os serviks. Ini adalah penyebab paling umum dari perdarahan tanpa rasa sakit di
trimester ketiga kehamilan.
2. Tanda dan Gejala
The most important sign is the repeated discharge of blood from the uterus through the
vagina without pain in the third trimester of pregnancy.
Tanda yang paling penting adalah keluarnya darah berulang kali dari rahim melalui vagina
tanpa rasa nyeri pada kehamilan trimester ketiga.
3. Etiologi Placenta Previa
Plasenta previa terjadi dikarenakan blastokista tertanam di segmen bawah rahim. Alasan
mengapa blastokista tertanam di segmen bawah rahim belum diketahui pasti hingga saat
ini. Salah satu penyebabnya disebukan adalah tidak memadainya vaskularisasi desidua
yang mungkin diakibatkan oleh proses peradangan ataupun atrofi. Faktor penyebab lain
seperti paritas tinggi, hamil pada usia lanjut, cacat pada rahim misalkan bekas bedah sesar,
mimektomi, kerokan, dan lainnya dapat berperan dalam proses peradangan dan terjadinya
atrofi pada endometrium.
Ukuran plasenta yang terlalu besar seperti pada eritroblastosis fetalis dan kehamilan ganda
bisa mengakibatkan penyakit plasenta previa. Hal ini disebabkan oleh pertumbuhan yang
melebar pada segmen bawah rahim sehingga menutupi seluruh atau sebagian ostium uteri
interna.
4. Penatalaksanaan Placenta Previa
Penanganan Pasif
Penanganan pasif unuk penderita adalah menjalani rawat inap di Rumah Sakit dengan
sikap berbaring di tempat tidur. Penderita boleh pulang apabila ternyata bukan plasenta
previa atau sudah selesai melahirkan.
Penanganan Aktif
Penanganan aktif berarti penyelesaian persalinan dengan segera. Manakala penanganan
aktif hendak dilakukan maka pilihannya hanya dua, yaitu melahirkan melalui vagina atau
melalui abdomen. Keputusannya bergantung kepada hasil pemeriksaan.
5. EBN
a. Charles J Lockwood, MD, MHCM. 2018. Placenta previa: Management

Acute management of bleeding previa :

●An actively bleeding placenta previa is a potential obstetric emergency. Women with
active bleeding are hospitalized for close maternal and fetal monitoring, including
(see 'Maternal and fetal assessment'above and 'Laboratory testing' above):

•Monitoring maternal blood loss and hemodynamic status.

•Obtaining a complete blood count and sending blood for type and antibody screen or
cross-match, depending on the likelihood of transfusion.
 •Evaluation of fibrinogen level, activated partial thromboplastin time, and prothrombin
time is indicated in patients suspected of coexistent abruption or with heavy blood loss
resulting in hemodynamic instability.

•Fetal heart rate monitoring.

b. Atsuko Sekiguchi. 2013. Type and Location of Placenta Previa Affect Preterm
Delivery Risk Related to Antepartum Hemorrhage
Analysis of maternal complications indicateda significant difference of blood loss
among groups including women without risk (� = 0.02). One case resulted in massive
blood loss (13,310 ml) following hysterectomy. This case had two findings composed
of bladder line interruption and placenta lacunae and involved an emergency cesarean
section due to uncontrollable bleeding followed by removal of the placenta. Except for
the group with two findings, including the aforementioned massive bleeding case, the
mean blood loss was 2186 ml or less in the other study groups. There was no
difference of blood loss between women that were highly suspicious for MAP and
women without risk (2186 ± 1438 ml versus 1656 ± 848 ml, resp.; � = 0.34) (Table 2).
The incidence of blood transfusion did not differ among the groups including women
without risk (� = 0.06). Additionally, the incidence of emergency cesarean section did
not differ among the groups including women without risk (� = 0.58). Bladder injury
only occurred in one of the women highly suspicious for MAP. The case was treated
by surgical repair followed by an uncomplicated postoperative course. There was no
difference of postoperative hospital stay among the groups including women without
risk (� = 0.26).