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HWN Suggests

Placenta previa

Placenta previa is a potentially life-threatening diagnosis often complicated by accreta. While definitive management requires advanced obstetric care, appropriate ED care is essential. These conditions should be considered in all cases of second and third trimester vaginal bleeding even when transabdominal ultrasonography has previously demonstrated no abnormality… Digital examination is contraindicated.

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 EM@3AM: Placenta Previa

Placenta previa is the presence of placental tissue overlying the internal cervical os and is a common cause of painless vaginal bleeding in women beyond 20 weeks gestation. Patients classically present with painless bleeding in the second or third trimester. Most cases of placenta previa are not seen on first-trimester ultrasound, and any woman without a second- or third-trimester ultrasound that presents with antepartum vaginal bleeding needs to have an abdominal ultrasound to assess the location of the placenta.

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Placenta Previa and Placenta Abruption

The abnormally implanted placenta may partially or entirely cover the cervix. Pregnancies complicated with placenta previa often present with painless vaginal bleeding after 20 weeks of gestation and are thereafter confirmed and classified on obstetric ultrasonography.

PV bleeding in late pregnancy - abruption, placenta praevia, etc

occurs in 1 in 250 births. bleeding is generally painless although 10-20% also develop contractions. 10% reach term without bleeding.

The Bleeding Pregnant Patient in the Third Trimester: Pearls and Pitfalls

The differential for third trimester bleeding includes placental abruption, placenta previa, and vasa previa. Vaginal speculum and bimanual exams are contraindicated with these diagnoses due to the risk of inciting massive hemorrhage.

Third Trimester Vaginal Bleeding

Never do a pelvic exam...