7: Vaginal Bleeding

Question 1

Placenta partially covers the cervical os. Birth is unlikely to be accomplished vaginally.

Answer 1

Partial placenta previa

Question 2

Abnormal proliferation of placental tissue that results in development of a benign or malignant tumor.

Answer 2

Gestational trophoblastic disease (hydatidiform mole)

Question 3

Placenta lies within 2-5 cm of the cervical os but does not cover it. Vaginal birth is probably, as the placenta will most likely migrate as the pregnancy progresses.

Answer 3

Low-lying placenta previa

Question 4

The most common type of placenta previa.

Answer 4

Low-lying placenta previa

Question 5

Placenta totally covers the cervical os. Birth cannot be accomplished vaginally.

Answer 5

Complete placenta previa

Question 6

Implantation of the placenta in the lower segment of the uterus.

Answer 6

Placenta previa

Question 7

Implantation of fertilized ovum outside uterus.

Answer 7

Ectopic pregnancy

Question 8

Placenta lies within 2 cm of the cervical os but does not cover the cervical os. Birth may occur vaginally.

Answer 8

Marginal placenta previa

Question 9

Symptoms of SAB present. Products of conception intact.

Answer 9

Threatened abortion

Question 10

Vaginal bleeding in the setting of villi adhering to the myometrium.

Answer 10

Placenta accreta (extends through myometrium)
Placenta increta (extends into myometrium)

Question 11

Products of conception expelled in entirety following symptoms of SAB.

Answer 11

Complete abortion

Question 12

Three or more SABS occurring consecutively.

Answer 12

Recurrent abortions

Question 13

Premature separation of the placenta from vaginal wall. Occurs in presence of obvious vaginal bleeding. Maternal hemorrhage.

Answer 13

Abruptio placentae

Question 14

Symptoms of SAB increased in severity, to include cervical dilation. Products of conception intact.

Answer 14

Inevitable abortion

Question 15

Symptoms of SAB present, to include cervical dilation. Partial products of conception expelled.

Answer 15

Incomplete abortion

Question 16

Products of conception retained for up to 6 weeks following symptoms of SAB.

Answer 16

Missed abortion

Question 17

Painless vaginal bleeding is the hallmark symptom. Usually occurs in late pregnancy (after 24 weeks) and is usually bright red.

Answer 17

Placenta previa

Question 18

Pregnancy loss prior to 20 weeks.

Answer 18

SAB

Question 19

Painful, bright red vaginal bleeding (heavy) and the sudden onset of sharp, localized abdominal pain.

Answer 19

Abruptio placenta

Question 20

Risk factors for SAB?

Answer 20

1. Advancing maternal age
2. Endocrine disorders such as thyroid disease and polycystic ovarian syndrome
3. History of SAB
4. Viral and bacterial infections
5. Anatomic reproductive disorders such as a malformed uterus
6. Chronic diseases
7. Exposure to environmental hazards

Question 21

Differential diagnoses for SAB?

Answer 21

1. Reproductive cancers
2. Ectopic pregnancy
3. Hydatidiform mole
4. Implantation bleeding
5. Polyps
6. Inflammation or infection

Question 22

What is the workup for SAB?

Answer 22

Diagnosis of SAB requires assessing uterine size by either physical examination or ultrasound, identifying if fetal heart tones are present by either auscultation or ultrasound, examination of the cervical os to determine if it is dilated, and serial β-hCG measurements.

Question 23

Which type of previas can have vaginal deliveries?

Answer 23

Marginal previa (maybe)
Low-lying likely will have vaginal as placenta migrates as pregnancy progresses.

Question 24

Which type of previas can’t have vaginal deliveries?

Answer 24

Complete previa

Partial previa