Placenta previa: Difference between revisions
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Tintinalli | Tintinalli | ||
Revision as of 04:25, 26 June 2016
Background
- 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
Diagnosis
- 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
Treatment
- Fluids Resus/Blood Products
- C-section
- Neonatal/Maternal Resus as needed
References
Tintinalli