Placenta previa - Revision history

Danbot: Strip excess bold

2026-03-22T09:35:28Z

Strip excess bold

← Older revision		Revision as of 09:35, 22 March 2026
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	[[File:Placenta previa.png\|thumb\|Placenta previa subtypes.]]		[[File:Placenta previa.png\|thumb\|Placenta previa subtypes.]]
	*Placenta that implants over or near the internal cervical os		*Placenta that implants over or near the internal cervical os
	**~~'''~~Complete~~'''~~ — entirely covers the os		**Complete — entirely covers the os
	**~~'''~~Partial~~'''~~ — partially covers the os		**Partial — partially covers the os
	**~~'''~~Marginal~~'''~~ — edge within 2 cm of the os		**Marginal — edge within 2 cm of the os
	*Occurs in ~0.5% of pregnancies at term<ref name="cress">Cresswell JA, et al. Prevalence of placenta praevia by world region: a systematic review and meta-analysis. ''Trop Med Int Health''. 2013;18(6):712-724. PMID 23551357.</ref>		*Occurs in ~0.5% of pregnancies at term<ref name="cress">Cresswell JA, et al. Prevalence of placenta praevia by world region: a systematic review and meta-analysis. ''Trop Med Int Health''. 2013;18(6):712-724. PMID 23551357.</ref>
	*Leading cause of [[Antepartum hemorrhage\|antepartum hemorrhage]] in the third trimester		*Leading cause of [[Antepartum hemorrhage\|antepartum hemorrhage]] in the third trimester
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	==Clinical Features==		==Clinical Features==
	*~~'''~~Painless~~'''~~, bright red [[Vaginal bleeding in pregnancy (greater than 20wks)\|vaginal bleeding]] — typically in late 2nd or 3rd trimester		*Painless, bright red [[Vaginal bleeding in pregnancy (greater than 20wks)\|vaginal bleeding]] — typically in late 2nd or 3rd trimester
	*Initial "sentinel bleed" often self-limited		*Initial "sentinel bleed" often self-limited
	*May present with profuse hemorrhage and [[Hemorrhagic shock\|hemodynamic instability]]		*May present with profuse hemorrhage and [[Hemorrhagic shock\|hemodynamic instability]]
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	==Evaluation==		==Evaluation==
	*~~'''~~[[Transabdominal ultrasound]]~~'''~~ — first-line to confirm placental position		*[[Transabdominal ultrasound]] — first-line to confirm placental position
	**Transvaginal US is safe and more accurate than transabdominal<ref name="bhide">Bhide A, et al. Placental praevia: diagnosis and management. ''Green-top Guideline No. 27a, RCOG''. 2018. PMID 35852513.</ref>		**Transvaginal US is safe and more accurate than transabdominal<ref name="bhide">Bhide A, et al. Placental praevia: diagnosis and management. ''Green-top Guideline No. 27a, RCOG''. 2018. PMID 35852513.</ref>
	*~~'''~~Labs~~'''~~		*Labs
	**Type and screen / crossmatch (prepare for massive transfusion)		**Type and screen / crossmatch (prepare for massive transfusion)
	**[[Rh factor\|Rh status]] — administer [[RhoGAM]] if Rh-negative		**[[Rh factor\|Rh status]] — administer [[RhoGAM]] if Rh-negative
	**CBC, coagulation studies (PT/INR, fibrinogen)		**CBC, coagulation studies (PT/INR, fibrinogen)
	*~~'''~~Fetal monitoring~~'''~~ — continuous cardiotocography		*Fetal monitoring — continuous cardiotocography
	*Consider [[Kleihauer-Betke test]] to quantify fetomaternal hemorrhage		*Consider [[Kleihauer-Betke test]] to quantify fetomaternal hemorrhage

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	==Disposition==		==Disposition==
	*All patients with placenta previa and vaginal bleeding require ~~'''~~admission~~'''~~		*All patients with placenta previa and vaginal bleeding require admission
	*Asymptomatic previa diagnosed on routine US — outpatient OB follow-up with pelvic rest		*Asymptomatic previa diagnosed on routine US — outpatient OB follow-up with pelvic rest

Danbot: Expand with EM-focused content, add references, fix duplicate heading, structured management

2026-03-21T18:28:28Z

Expand with EM-focused content, add references, fix duplicate heading, structured management

← Older revision		Revision as of 18:28, 21 March 2026
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	[[File:Placta prv.jpg\|thumb\|Schematic of placenta previa.]]		[[File:Placta prv.jpg\|thumb\|Schematic of placenta previa.]]
	[[File:Placenta previa.png\|thumb\|Placenta previa subtypes.]]		[[File:Placenta previa.png\|thumb\|Placenta previa subtypes.]]
	*Placenta that ~~extends near, partially~~ over, or ~~beyond~~ the internal cervical os		*Placenta that implants over or near the internal cervical os
	**~~Can be total~~, ~~partial, or marginal~~		**'''Complete''' — entirely covers the os
	*Do NOT perform digital or speculum exam		**'''Partial''' — partially covers the os
			**'''Marginal''' — edge within 2 cm of the os
			*Occurs in ~0.5% of pregnancies at term<ref name="cress">Cresswell JA, et al. Prevalence of placenta praevia by world region: a systematic review and meta-analysis. ''Trop Med Int Health''. 2013;18(6):712-724. PMID 23551357.</ref>
			*Leading cause of [[Antepartum hemorrhage\|antepartum hemorrhage]] in the third trimester
			*'''Do NOT perform digital or speculum exam''' — may provoke life-threatening hemorrhage

	==Risk Factors==		==Risk Factors==
	*~~Uterine scar~~		*Prior [[cesarean delivery]] or uterine surgery
	*Advanced maternal age		*Prior placenta previa (recurrence 4-8%)
	*Cigarette smoking		*Advanced maternal age (>35)
	*[[Cocaine]] ~~abuse~~		*Multiparity
			*[[Cigarette smoking]]
			*[[Cocaine]] use
			*Assisted reproduction (IVF)

	==Clinical Features==		==Clinical Features==
	*Painless [[Vaginal bleeding in pregnancy (greater than 20wks)\|vaginal bleeding]] in 3rd trimester		*'''Painless''', bright red [[Vaginal bleeding in pregnancy (greater than 20wks)\|vaginal bleeding]] — typically in late 2nd or 3rd trimester
	**May be profuse~~, bright red~~		*Initial "sentinel bleed" often self-limited
			*May present with profuse hemorrhage and [[Hemorrhagic shock\|hemodynamic instability]]
			*Uterus is soft and non-tender (distinguishes from [[Placental abruption\|abruption]])
			*Fetal heart tones usually normal unless maternal shock present

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*[[~~Pelvic~~ ultrasound]] - ~~obtain~~ position ~~of placenta~~		*'''[[Transabdominal ultrasound]]''' — first-line to confirm placental position
	*Type ~~+ cross~~		**Transvaginal US is safe and more accurate than transabdominal<ref name="bhide">Bhide A, et al. Placental praevia: diagnosis and management. ''Green-top Guideline No. 27a, RCOG''. 2018. PMID 35852513.</ref>
	*~~Rho~~ status		*'''Labs'''
	*CBC		**Type and screen / crossmatch (prepare for massive transfusion)
	*~~Coags~~		**[[Rh factor\|Rh status]] — administer [[RhoGAM]] if Rh-negative
	*~~Fetal Heart Monitoring~~		**CBC, coagulation studies (PT/INR, fibrinogen)
			*'''Fetal monitoring''' — continuous cardiotocography
			*Consider [[Kleihauer-Betke test]] to quantify fetomaternal hemorrhage

	~~==Evaluation==~~
	==Management==		==Management==
	*~~Requires~~ cesarean- consult ob/~~gyn emergently~~		===Hemodynamically Unstable / Active Hemorrhage===
	*~~Resuscitate~~		*Aggressive IV fluid resuscitation with crystalloid
			*Activate [[Massive transfusion protocol\|massive transfusion protocol]] as needed
			*'''Emergent cesarean delivery''' — consult OB/GYN immediately
			*Goal: maternal stabilization takes priority

			===Stable Patient===
			*Admit to labor and delivery
			*Strict bed rest, NPO
			*Continuous fetal monitoring
			*OB/GYN consultation for delivery planning
			*If preterm (<34 weeks): [[Betamethasone\|antenatal corticosteroids]] for fetal lung maturity
			*If preterm with contractions: [[Tocolytics\|tocolysis]] may be considered

	==~~Dispo~~==		==Disposition==
	*~~Admit~~		*All patients with placenta previa and vaginal bleeding require '''admission'''
			*Asymptomatic previa diagnosed on routine US — outpatient OB follow-up with pelvic rest

	==See Also==		==See Also==
			*[[Placental abruption]]
	*[[Vaginal Bleeding (Main)]]		*[[Vaginal Bleeding (Main)]]
			*[[Vasa previa]]
			*[[Postpartum hemorrhage]]

	==References==		==References==
	<references/>		<references/>


	[[Category:OBGYN]]		[[Category:OBGYN]]

Rossdonaldson1: /* Background */

2024-12-11T23:11:47Z

Background

← Older revision		Revision as of 23:11, 11 December 2024
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	[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]		[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]
	[[File:Placta prv.jpg\|thumb\|Schematic of placenta previa.]]		[[File:Placta prv.jpg\|thumb\|Schematic of placenta previa.]]
			[[File:Placenta previa.png\|thumb\|Placenta previa subtypes.]]
	*Placenta that extends near, partially over, or beyond the internal cervical os		*Placenta that extends near, partially over, or beyond the internal cervical os
	**Can be total, partial, or marginal		**Can be total, partial, or marginal

Rossdonaldson1: /* Background */

2024-12-11T21:31:33Z

Background

← Older revision		Revision as of 21:31, 11 December 2024
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	==Background==		==Background==
	[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]		[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]
			[[File:Placta prv.jpg\|thumb\|Schematic of placenta previa.]]
	*Placenta that extends near, partially over, or beyond the internal cervical os		*Placenta that extends near, partially over, or beyond the internal cervical os
	**Can be total, partial, or marginal		**Can be total, partial, or marginal

Rossdonaldson1: /* Background */

2022-12-14T19:25:24Z

Background

← Older revision		Revision as of 19:25, 14 December 2022
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	==Background==		==Background==
	#Placenta that extends near, partially over, or beyond the internal cervical os		[[File:2910 The Placenta-02.jpg\|thumb\|Normal placental anatomy.]]
	##Can be total, partial, or marginal		*Placenta that extends near, partially over, or beyond the internal cervical os
	#Do NOT perform digital or speculum exam		**Can be total, partial, or marginal
			*Do NOT perform digital or speculum exam

	==Risk Factors==		==Risk Factors==

ClaireLewis at 02:02, 4 October 2019

2019-10-04T02:02:27Z

← Older revision		Revision as of 02:02, 4 October 2019
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	*[[Cocaine]] abuse		*[[Cocaine]] abuse

	==~~Evaluation~~==		==Clinical Features==
	*Painless vaginal bleeding		*Painless [[Vaginal bleeding in pregnancy (greater than 20wks)\|vaginal bleeding]] in 3rd trimester
	*~~U/S - obtain position of placenta~~		**May be profuse, bright red


	==Differential Diagnosis==		==Differential Diagnosis==
	{{Abdominal Pain Pregnancy DDX}}		{{Abdominal Pain Pregnancy DDX}}

	==~~Management~~==		==Evaluation==
			*[[Pelvic ultrasound]] - obtain position of placenta
	*Type + cross		*Type + cross
	*Rho status		*Rho status
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	*Coags		*Coags
	*Fetal Heart Monitoring		*Fetal Heart Monitoring
	*Consult OBGYN and NICU/Neonatal/Peds Immediately

			==Evaluation==
	==Management==		==Management==
	*~~Fluids Resus~~/~~Blood Products~~		*Requires cesarean- consult ob/gyn emergently
	*~~C-section~~		*Resuscitate
	*~~Neonatal/Maternal Resus as needed~~
			==Dispo==
			*Admit

			==See Also==
			*[[Vaginal Bleeding (Main)]]

	==References==		==References==
	<references/>		<references/>


	~~==See Also==~~
	~~[[Vaginal Bleeding (Main)]]~~

	[[Category:OBGYN]]		[[Category:OBGYN]]

Jesse: /* Risk Factors */

2017-08-28T23:45:58Z

Risk Factors

← Older revision		Revision as of 23:45, 28 August 2017
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	*Advanced maternal age		*Advanced maternal age
	*Cigarette smoking		*Cigarette smoking
	*[[Cocaine]]abuse		*[[Cocaine]] abuse

	==Evaluation==		==Evaluation==

Ostermayer: Text replacement - "Cocaine " to "Cocaine"

2017-03-10T13:28:42Z

Text replacement - "Cocaine " to "Cocaine"

← Older revision		Revision as of 13:28, 10 March 2017
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	*Advanced maternal age		*Advanced maternal age
	*Cigarette smoking		*Cigarette smoking
	*Cocaine abuse		*[[Cocaine]]abuse

	==Evaluation==		==Evaluation==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-25T14:31:05Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 14:31, 25 July 2016
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	*Cocaine abuse		*Cocaine abuse

	==~~Diagnosis~~==		==Evaluation==
	*Painless vaginal bleeding		*Painless vaginal bleeding
	*U/S - obtain position of placenta		*U/S - obtain position of placenta

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-07T23:35:56Z

Text replacement - "==Treatment==" to "==Management=="

← Older revision		Revision as of 23:35, 7 July 2016
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	*Consult OBGYN and NICU/Neonatal/Peds Immediately		*Consult OBGYN and NICU/Neonatal/Peds Immediately

	==~~Treatment~~==		==Management==
	*Fluids Resus/Blood Products		*Fluids Resus/Blood Products
	*C-section		*C-section