Placental previa Flashcards
What is a placental previa?
Partial or complete covering of the internal cervical opening
How is placenta previa diagnosed?
- Transvaginal ultrasound
- MRI
If a placenta previa is identified on first trimester ultrasound how likely is it to persist into the third trimester?
15-19 weeks: 88% will resolve 20-23 weeks: 64% will resolve 24-27 weeks: 51% will resolve 28-31 weeks: 38% will resolve 32-35 weeks: 27% will resolve
If a placenta previa is seen on mid trimester ultrasound how will you follow this patient?
- fetal growth if stable
- repeat transvaginal at 32 weeks and if not resolved, repeat again at 36 weeks
How do you counsel a patient if a placenta previa is noted on her 32 weeks ultrasound?
approximately 27% will resolve by 35 weeks but the likelihood of resolution is low.
When is delivery recommended for placenta previa?
36-37 weeks gestation
How do you manage a patient who presents with bleeding and a placenta previa in pregnancy?
Assess hemodynamics and fetal wellbeing
Add betamethasone with viability
When do you recommend hospitalization for patients with a placenta previa?
> 3 bleeding episodes or long distance from hospital in the setting of hemodynamic stability
Do you recommend bedrest for patients with a placenta previa?
No but recommend limiting increase pelvic pressure and recommend pelvic rest
What are the maternal risks with a placenta previa?
- Hemorrhage
- Need for blood transfusion
- Need for cesarean section
- Increased hospitalization
- Need for hysterectomy particularly if associated with history of cesarean section and MAP
- Maternal death
What are the fetal risks with a placenta previa?
- Preterm delivery
- Neonatal morbidity/mortality is doubled due to preterm delivery
- Lower birth weight and APGAR score
What is the chance of invasive placentation in patient with a previa with prior uterine surgeries?
1st cesarean - 3% 2nd cesarean - 11% 3rd cesarean - 40% 4th cesarean - 61% 5th cesarean - 67%
