Placenta Previa

Question 0

Antepartum vaginal bleeding?

Most common causes of significant antepartum bleeding

Answer 0

Vaginal bleeding after 20 weeks gestation

Placenta abruption and placenta previa

Question 1

Suspected placenta previa – next step? Long-term management?

Answer 1

Ultrasound;

expectant management as long as bleeding not excessive, C-section at 36-37 weeks gestation

Question 2

1. Complete placenta previa
2. Partial placenta previa
3. Marginal placenta previa
4. Low lying placenta?

Answer 2

1. Placenta that completely covers internal os
2. Placenta partially covers internal os
3. Placenta abuts against the internal os
4. Edge of placenta is within 2-3 cm of internal os

Question 3

Vasa previa? Complication?

Answer 3

Umbilical cord vessels overlie internal cervical os

Fetal exsanguination upon rupture of membranes

Question 4

placenta previa versus placental abruption: clinical presentation? Test?

Answer 4

Painless bleeding (Spotting after coitus) after mid-second trimester
versus
Profuse first episode of bleeding, coagulopathy, painful contractions

Ultrasound versus no diagnostic test

Question 5

Patient complaining of antepartum bleeding – order of next steps?

Answer 5

1. Ultrasound – r/o previa
2. speculum – assess for lacerations
3. digital examination

Question 6

Placenta previa – when to do delivery?

Answer 6

If over 37 weeks, schedule C-section

Otherwise, Second or third episode of bleeding (after first episode, patient typically put on bed rest)

Question 7

Complication of placenta abruption?

Answer 7

Coagulopathy

Question 8

Risk factors for placenta previa?

Answer 8

1. Multiparity
2. Prior C-section
3. Prior uterine curettage
4. Previous placenta Pravia
5. Multiple gestation

Question 9

Pt with placenta previous – when to do delivery? How to deliver? Increased risk of?

Answer 9

After fetal lungs have matured, C-section

Placenta accreta – invasion of placenta into uterus