Placenta previa

Background

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

Risk Factors

• Uterine scar
• Advanced maternal age
• Cigarette smoking
• Cocaine abuse

Evaluation

• Painless vaginal bleeding
• U/S - obtain position of placenta

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

• Labor/Preterm labor
• Placental abruption
• Placenta previa
• Vasa previa
• Uterine rupture
• Vaginal trauma
• HELLP syndrome
• Cholestasis of pregnancy
• Chorioamnionitis
• Incarcerated uterus
• Acute fatty liver of pregnancy
• Malposition of the uterus
• Placenta accreta
• Placenta increta
• Placenta percreta

Any time

• Hemorrhagic ovarian cyst
• Fibroid degeneration or torsion
• Ovarian torsion
• Constipation

Management

• Type + cross
• Rho status
• CBC
• Coags
• Fetal Heart Monitoring
• Consult OBGYN and NICU/Neonatal/Peds Immediately

Management

• Fluids Resus/Blood Products
• C-section
• Neonatal/Maternal Resus as needed

See Also

Vaginal Bleeding (Main)