Difference between revisions of "Placenta previa"

(Risk Factors)
 
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==Background==
 
==Background==
# placenta improperly positioned between cervic and baby. can be total, partial or marginal
+
#Placenta that extends near, partially over, or beyond the internal cervical os
# tx c c section
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##Can be total, partial, or marginal
# 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)
+
#Do NOT perform digital or speculum exam
# assoc with intrauterine growth retardation, congenital abnormalities, and placenta prev.
 
  
 
==Risk Factors==
 
==Risk Factors==
# c section
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*Uterine scar
# previous pl previa
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*Advanced maternal age
# twins
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*Cigarette smoking
# D&C
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*[[Cocaine]] abuse
# muliparous
 
# scarring of uterus with no place for placenta to attach except at botton near cervix
 
  
==Diagnosis==
+
==Evaluation==
# painless bright red blood
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*Painless vaginal bleeding
# exam only with double set up in OR by obstetrician
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*U/S - obtain position of placenta
# 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==
# c section
+
{{Abdominal Pain Pregnancy DDX}}
# if fetus not viable, tx in hospital until viable then c section
 
  
[[Category:OB/GYN]]
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==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
 +
 
 +
==References==
 +
<references/>
 +
 
 +
 
 +
==See Also==
 +
[[Vaginal Bleeding (Main)]]
 +
 
 +
[[Category:OBGYN]]

Latest revision as of 23:45, 28 August 2017

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 pathologies as non-pregnant patients, plus:

<20 Weeks

>20 Weeks

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

References


See Also

Vaginal Bleeding (Main)