Placenta previa

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

• Painless vaginal bleeding in 3rd trimester
  • May be profuse, bright red

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

Evaluation

• Pelvic ultrasound - obtain position of placenta
• Type + cross
• Rho status
• CBC
• Coags
• Fetal Heart Monitoring

Management

• Requires cesarean- consult ob/gyn emergently
• Resuscitate

Dispo

• Admit

See Also

• Vaginal Bleeding (Main)