Placenta previa: Difference between revisions

Latest revision as of 23:11, 11 December 2024

Background

Normal placental anatomy.

Schematic of placenta previa.

Placenta previa subtypes.

Placenta that extends near, partially over, or beyond the internal cervical os
- Can be total, partial, or marginal
Do NOT perform digital or speculum exam

Risk Factors

Uterine scar
Advanced maternal age
Cigarette smoking
Cocaine abuse

Clinical Features

Painless vaginal bleeding in 3rd trimester
- May be profuse, bright red

Differential Diagnosis

Abdominal Pain in Pregnancy

The same abdominal pain differential as non-pregnant patients, plus:

<20 Weeks

Ectopic pregnancy
First trimester abortion
- Complete abortion
- Threatened abortion
- Inevitable abortion
- Incomplete abortion
- Missed abortion
- Septic abortion
Round ligament stretching
Incarcerated uterus
Malposition of the uterus

>20 Weeks

Any time

Hemorrhagic ovarian cyst
Fibroid degeneration or torsion
Ovarian torsion
Constipation

Evaluation

Pelvic ultrasound - obtain position of placenta
Type + cross
Rho status
CBC
Coags
Fetal Heart Monitoring

Evaluation

Management

Requires cesarean- consult ob/gyn emergently
Resuscitate

Dispo

Admit

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-# placenta improperly positioned between cervic and baby. can be total, partial or marginal
+[[File:2910 The Placenta-02.jpg|thumb|Normal placental anatomy.]]
-# tx c c section
+[[File:Placta prv.jpg|thumb|Schematic of placenta previa.]]
-# hem from early separation of placenta from ut- due to gradual thinning of cervix in anticipation of delivery.  can also be by physical exertion, labor, local trauma (intercourse, speculum exam)
+[[File:Placenta previa.png|thumb|Placenta previa subtypes.]]
-# assoc with intrauterine growth retardation, congenital abnormalities, and placenta prev.
+*Placenta that extends near, partially over, or beyond the internal cervical os
+**Can be total, partial, or marginal
+*Do NOT perform digital or speculum exam
 ==Risk Factors==
-# c section
+*Uterine scar
-# previous pl previa
+*Advanced maternal age
-# twins
+*Cigarette smoking
-# D&C
+*[[Cocaine]] abuse
-# muliparous
-# scarring of uterus with no place for placenta to attach except at botton near cervix
-==Diagnosis==
+==Clinical Features==
-# painless bright red blood
+*Painless [[Vaginal bleeding in pregnancy (greater than 20wks)|vaginal bleeding]] in 3rd trimester
-# exam only with double set up in OR by obstetrician
+**May be profuse, bright red
-# in ER use abd utz
-# 90% of prev dx before 20 wks will have placnta that migrates away from cervix or lower ut  segmnt will grow more
-==Treatment==
-# c section
-# if fetus not viable, tx in hospital until viable then c section
-[[Category:OB/GYN]]
+==Differential Diagnosis==
+{{Abdominal Pain Pregnancy DDX}}
+==Evaluation==
+*[[Pelvic ultrasound]] - obtain position of placenta
+*Type + cross
+*Rho status
+*CBC
+*Coags
+*Fetal Heart Monitoring
+==Evaluation==
+==Management==
+*Requires cesarean- consult ob/gyn emergently
+*Resuscitate
+==Dispo==
+*Admit
+==See Also==
+*[[Vaginal Bleeding (Main)]]
+==References==
+<references/>
+[[Category:OBGYN]]