Placenta Previa Overview
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What results from the placenta totally or partially being implanted in the lower uterine segment which is thinner and less vascularized?

Placenta previa

What occurs when the placental tissue covers the cervical os in any degree?

True placenta previa

What occurs when the placenta is within 2 cm of the cervical os?

Low-lying placenta

What is the presentation for placenta previa?

<p>Painless bright red bleeding without uterine tenderness</p> Signup and view all the answers

What is common in placenta previa due to the placenta occupying the lower uterine segment making the presenting part remain high?

<p>Fetal malpresentation</p> Signup and view all the answers

What is placenta previa more common in?

<p>Nulliparous individuals</p> Signup and view all the answers

Which of these are risk factors/etiologies for placenta previa?

<p>Endometrial scarring (A), Impediment of endometrial vascularization (from chronic disease) (B), Increased placental mass (multiples) (C), Race (Asian) (D), High Altitude (E), Infertility treatments (F), Male offspring (G)</p> Signup and view all the answers

What diagnostic testing will be used for placenta previa?

<p>Transabdominal ultrasound (A), Transvaginal ultrasound (B)</p> Signup and view all the answers

Which of these are fetal/neonatal effects of placenta previa?

<p>Prematurity (A), Malpresentation (B), Intrauterine growth restriction (IUGR) (C), Fetal anemia (D)</p> Signup and view all the answers

Which of these are maternal effects of placenta previa?

<p>Hemorrhage (A), Hypovolemic shock (B), D-sensitization (Rhogham!!!) (C), Postpartum anemia (D), Postpartum infection (E)</p> Signup and view all the answers

If a patient is asymptomatic and > 16 weeks with low-lying placenta or previa, what is the management?

<p>Ultrasound at 32 weeks and if it persists, ultrasound at 36 weeks</p> Signup and view all the answers

What will be indicated for a patient with placenta previa who is symptomatic?

<p>Hospitalization</p> Signup and view all the answers

How should fetal monitoring occur for a hospitalized patient with placenta previa?

<p>Continuous electronic fetal monitoring with bleeding then Q4 hours</p> Signup and view all the answers

What should twice weekly testing occur with for placenta previa (no contractions wanted)?

<p>Amniotic fluid index</p> Signup and view all the answers

What should be considered if a patient is < 34 weeks with placenta previa and hospitalized?

<p>Corticosteroids</p> Signup and view all the answers

When should birth definitely take place for placenta previa?

<p>Once fetal maturity is proven</p> Signup and view all the answers

What will occur for all placenta previa patients with ultrasound evidence?

<p>Cesarean section Normal and no complications: 36-37 weeks Complications: Immediate (regardless of fetal age)</p> Signup and view all the answers

What occurs from defective maternal vessels in the decidua basalis which eventually rupture and separate between the placenta and uterine wall (bleeding is usually of maternal origin)?

<p>Placental abruption</p> Signup and view all the answers

What are most placental abruptions a result of?

<p>A chronic process</p> Signup and view all the answers

What type of placental abruption will have blood accumulation behind the placenta with no obvious vaginal bleeding?

<p>Central/concealed</p> Signup and view all the answers

Which of these are risk factors for placental abruption?

<p>Increased parity (A), Chronic disease (B), Prior abruption (C), Trauma (D), Substance use (E), Sudden decompression (PROM, PPROM) (F), Uterine/placental factors (anomalies, synechiae, leiomyoma, c section scar) (G)</p> Signup and view all the answers

How will vaginal bleeding present in a placental abruption?

<p>Dark red vaginal bleeding, non-clotting</p> Signup and view all the answers

Which of these symptoms are associated with placental abruption?

<p>Abdominal/back pain (A), Uterine hypertonus (B), Uterine contractions (C), Uterine tenderness (D), Fetal distress or fetal death (E), Hypovolemia (beyond expected) (F)</p> Signup and view all the answers

What are maternal effects of placental abruption?

<p>Postpartum morbidity (A), Anemia (B), Coagulopathy (infection, hemorrhage, DIC end organ damage) (C)</p> Signup and view all the answers

What type of bleeding for placental abruption is the worst case scenario identified on ultrasound (ultrasound only identifies < 2% of abruptions because bleeding must be significant)?

<p>Retro placental</p> Signup and view all the answers

What is the result of velamentous vessels crossing the region of the internal os and occupying a position ahead of the presenting part where they are at risk for compression and/or rupture?

<p>Vasa previa</p> Signup and view all the answers

Which of these are risk factors for vasa previa?

<p>Bilobed and succenturiate lobed placentas (A), Assisted reproductive technology (ART) (B), Multiple gestations (C), History of 2nd trimester previa or low-lying placenta (D)</p> Signup and view all the answers

Which of these are signs of vasa previa?

<p>Feeling umbilical vessels during exam (A), Fetal heart rate decreases then returns to baseline during exam (B), Visualizing vessels in ultrasound (C)</p> Signup and view all the answers

What is the most common sign/symptom associated with vasa previa?

<p>Vaginal bleeding at the time of membranes rupturing</p> Signup and view all the answers

When is birth recommended for vasa previa?

<p>Early birth (34-36 weeks)</p> Signup and view all the answers

When should twice weekly testing begin for a patient with vasa previa?

<p>28-32 weeks</p> Signup and view all the answers

What will likely result for the fetus if vessels rupture in vasa previa?

<p>Death</p> Signup and view all the answers

What can result from umbilical vessels not having Wharton's jelly and being easily compressed affecting fetal blood flow in vasa previa?

<p>Fetal deformities</p> Signup and view all the answers

Flashcards

placenta previa

Condition where placenta is implanted in the lower uterine segment.

true placenta previa

Placental tissue completely covers the cervical os.

low lying placenta

Placenta is within 2 cm of the cervical os.

presentation of placenta previa

Painless bright red bleeding without uterine tenderness.

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fetal malpresentation

Occurs due to the placenta occupying the lower uterine segment.

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risk factors for placenta previa

Includes endometrial scarring and advanced maternal age.

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transvaginal ultrasound

Diagnostic test with 100% sensitivity for placenta previa.

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prematurity effects

Fetal/neonatal complications include prematurity and IUGR.

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maternal effects of placenta previa

Includes hemorrhage, hypovolemic shock, and anemia.

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asymptomatic low lying placenta management

Monitor with ultrasound at 32 and 36 weeks.

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hospitalization for placenta previa

Indicated for symptomatic patients with placenta previa.

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fetal monitoring for hospitalized patients

Continuous fetal monitoring with bleeding, then every 4 hours.

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corticosteroids use

Considered for patients < 34 weeks with placenta previa.

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placental abruption

Separation of the placenta from the uterine wall, often with vaginal bleeding.

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symptoms of placental abruption

Include dark red vaginal bleeding and abdominal pain.

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maternal effects of placental abruption

Can cause anemia, coagulopathy, and infection risks.

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fetal effects of placental abruption

Includes fetal hypoxia and potential neurological defects.

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vasa previa

Presence of velamentous vessels crossing the internal os.

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signs of vasa previa

Includes feeling umbilical vessels or observing decreased FHR.

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vasa previa risk factors

Includes prior pregnancies with low-lying placenta and multiple gestations.

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most common symptom of vasa previa

Vaginal bleeding at rupture of membranes.

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twice weekly testing for vasa previa

Should begin between 28-32 weeks gestation.

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fetal outcome of ruptured vessels in vasa previa

Likely results in fetal death if vessels rupture.

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fetal deformities due to vasa previa

Caused by umbilical vessels lacking protective Wharton's jelly.

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Study Notes

Placenta Previa

  • Definition: Placenta implanted in the lower uterine segment, potentially covering the cervix.
  • Types:
    • True Previa: Placenta completely or partially covers the cervical os.
    • Low-lying Placenta: Placenta within 2 cm of the cervical os.
  • Presentation: Painless, bright red bleeding without uterine tenderness.
  • Risk Factors/Etiologies: Nulliparity, endometrial scarring, impeded endometrial vascularization, increased placental mass (multiples), race (Asian), high altitude, infertility treatments, male offspring.
  • Diagnostics: Transabdominal ultrasound (90%), followed by transvaginal ultrasound (100%).
  • Fetal/Neonatal Effects: Prematurity, malpresentation, IUGR, and fetal anemia.
  • Maternal Effects: Hemorrhage, hypovolemic shock, Rh sensitization, postpartum anemia, and postpartum infection.
  • Management: Ultrasound at 32 weeks, and again at 36 weeks if bleeding persists. Hospitalization for symptomatic patients. Continuous fetal monitoring, with fetal activity monitoring every four hours, and amniotic fluid index measurements twice weekly (no CST). Corticosteroids if patient <34 weeks.
  • Delivery: Cesarean section at or before 36-37 weeks, depending on fetal maturity and any complications.

Placental Abruption

  • Definition: Separation of the placenta from the uterine wall due to defective maternal vessels in the decidua basalis. Usually a chronic process.
  • Presentation: Dark red, non-clotting vaginal bleeding.
  • Symptoms: Abdominal/back pain, uterine hypertonus (contractions and tenderness). Fetal distress or death possible. Hypovolemia.
  • Risk Factors: Increased parity, chronic disease, prior abruption, trauma, substance use, sudden decompression (PROM/PPROM), uterine/placental factors (anomalies, synechiae, leiomyoma, or C-section scar).
  • Types: Central/concealed (hidden bleeding) and retro-placental (worst case).
  • Maternal Effects: Postpartum morbidity, anemia, coagulopathy, potential infection and DIC.
  • Fetal Effects: Fetal hypoxia, oligohydramnios, neonatal prematurity, IUGR, and neuro defects.

Vasa Previa

  • Definition: Velamentous vessels (umbilical cord vessels that traverse the membranes before reaching the placenta) crossing the internal os. Risk of compression and rupture.
  • Risk Factors: Bilobed and succenturiate lobed placentas, ART, multiple gestations, history of second-trimester previa or low-lying placenta.
  • Signs: Feeling umbilical vessels during examination, decreased then returning FHR during exam, and visualization of vessels in ultrasound.
  • Presentation: Vaginal bleeding with rupture of membranes (PROM).
  • Fetal Complications: High risk of fetal death, fetal deformities due to blood flow impairment.
  • Management: Early delivery (34-36 weeks) recommended. Twice weekly testing starting at 28-32 weeks gestation.

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Description

This quiz explores the definition, types, and risk factors of placenta previa, along with diagnostic methods and maternal and fetal effects. It also discusses management strategies, emphasizing the importance of ultrasound screening in affected patients. Test your knowledge on this crucial topic in obstetrics!

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