Placental abnormalities

Question 1

The most common cause of painless third-trimester bleeding is … ?

Answer 1

placenta previa

Question 2

What is the strongest predisposing factor for placenta previa?

Answer 2

Uterine scarring, most commonly secondary to Cesarean sections or uterine surgeries.

Other risk factors for placenta previa:
- Advanced maternal age
- Multiparity
- Smoking
- Multiple gestations

Question 3

With any vaginal bleeding during the third trimester. what must NEVER be performed?

Answer 3

DO NOT perform digital exam!!!

Question 4

Why is a digital vaginal examination contraindicated in suspected placenta previa?

Answer 4

Vaginal examinations can worsen bleeding and cause complications due to disruption of placental vessels.

Question 5

What is the first step in evaluating third-trimester painless vaginal bleeding?

Answer 5

Transabdominal ultrasound to evaluate placental position and rule out placenta previa.

Question 6

What is the management for third-trimester painless vaginal bleeding?

Answer 6

• If the patient is stable but the fetus is still preterm: Pelvic rest, no digital exams, corticosteroids for lung maturity
• For severe bleeding or term gestation: Planned C-section

Question 7

What are the risk factors associated with Abruptio placentae?

Answer 7

Risk factors include maternal hypertension, abdominal trauma, or cocaine or tobacco use.