Review Question - QID 105186

This pregnant patient is presenting with painless vaginal bleeding which is most commonly caused by placenta previa.

Placenta previa occurs when the placenta forms over the cervical os. These patients must be delivered by cesarean section (C-section) since the placenta is covering the cervical os. Patients who have had a previous pregnancy delivered by C-section are at an increased risk of placenta previa in subsequent pregnancies. Any patient with painless vaginal bleeding should first have an ultrasound performed to confirm the diagnosis. A C-section can subsequently be scheduled since a vaginal delivery is not performed in placenta previa (unless the placenta migrates).

Incorrect Answers:
Answer 1: Placenta percreta occurs when the placenta invades through the myometrium and the serosal covering of the uterus. It can subsequently invade into nearby organs causing dysfunction (such as the colon or bladder). The diagnosis can be confirmed with an ultrasound or an MRI.

Answer 3: Placental abruption presents after trauma with painful vaginal bleeding. Risk factors include hypertension, smoking, and cocaine use. The diagnosis can be supported with an ultrasound and delivery via C-section is typically indicated.

Answer 4: Uterine rupture presents after trauma with painful vaginal bleeding, a loss of contractions, and palpable fetal parts. Treatment involves an immediate C-section and likely hysterectomy to stop the bleeding.

Answer 5: Vasa previa presents with painless vaginal bleeding and fetal heart rate abnormalities. The diagnosis can be supported with ultrasound and delivery via C-section is indicated immediately prior to fetal exsanguination.

Bullet Summary:
Placenta previa presents with painless vaginal bleeding and a placenta over the cervical os on ultrasound.