Difference between revisions of "Placenta previa"

 
(17 intermediate revisions by 8 users not shown)
Line 1: Line 1:
 
==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
+
##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
+
*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]]

Latest revision as of 02:02, 4 October 2019

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

Clinical Features


Differential Diagnosis

Abdominal Pain in Pregnancy

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

<20 Weeks

>20 Weeks

Any time

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

References