Difference between revisions of "Placenta previa"

(Created page with "==Background== - placenta improperly positioned between cervic and baby. can be total, partial or marginal - tx c c section - hem from early separation of placenta from ut- ...")
 
 
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==Background==
 
==Background==
 
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#Placenta that extends near, partially over, or beyond the internal cervical os
 
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##Can be total, partial, or marginal
- placenta improperly positioned between cervic and baby. can be
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#Do NOT perform digital or speculum exam
 
 
total, partial or marginal
 
 
 
- tx c c section
 
 
 
- 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).
 
 
 
- assoc with intrauterine growth retardation, congenital
 
 
 
abnormalities, and placenta prev.
 
 
 
 
  
 
==Risk Factors==
 
==Risk Factors==
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*Uterine scar
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*Advanced maternal age
 +
*Cigarette smoking
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*[[Cocaine]] abuse
  
 +
==Clinical Features==
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*Painless [[Vaginal bleeding in pregnancy (greater than 20wks)|vaginal bleeding]] in 3rd trimester
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**May be profuse, bright red
  
- c section
 
 
- previous pl previa
 
 
- twins
 
 
- D&C
 
 
-muliparous
 
 
- scarring of uterus with no place for placenta to attach except at
 
 
botton near cervix
 
 
 
 
==Diagnosis==
 
 
 
- painless bright red blood
 
 
- exam only with double set up in OR by obstetrician
 
 
- 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==
 
  
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==Differential Diagnosis==
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{{Abdominal Pain Pregnancy DDX}}
  
- c section
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==Evaluation==
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*[[Pelvic ultrasound]] - obtain position of placenta
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*Type + cross
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*Rho status
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*CBC
 +
*Coags
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*Fetal Heart Monitoring
  
- if fetus not viable, tx in hospital until viable then c section
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==Evaluation==
 +
==Management==
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*Requires cesarean- consult ob/gyn emergently
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*Resuscitate
  
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==Dispo==
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*Admit
  
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==See Also==
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*[[Vaginal Bleeding (Main)]]
  
 +
==References==
 +
<references/>
  
  
[[Category:OB/GYN]]
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[[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