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