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Vasa previa
6%
1/16
Uterine rupture
0%
0/16
Placenta previa
88%
14/16
Placental abruption
Cord prolapse
Select Answer to see Preferred Response
This is a patient in her third trimester of pregnancy with painless vaginal bleeding in the setting of a reassuring fetal heart tracing. Placenta previa is the most likely diagnosis. Placenta previa is the implantation of the placenta over the lower part of the uterus covering the internal cervical os. It occurs in less than one percent of all pregnancies and is typically diagnosed in asymptomatic women during routine ultrasounography in the second trimester. Placenta previa can be classified according to degree of obstruction of the internal os. Asymptomatic patients with minimal bleeding can be managed as outpatients with serial ultrasound, abstinence from sexual intercourse, avoidance of digital pelvic exams, and a scheduled cesarean delivery. Figure A shows a normal fetal heart tracing relative to uterine contractions. There is minimal deceleration or variability following each contraction, suggesting good placental exchange and no suggestions of fetal compromise. Incorrect Answers: Answer 1: Vasa previa involves unprotected fetal blood vessels running through the amniotic membranes and traversing the cervix. It typically presents with painless vaginal bleeding but also fetal bradycardia and late decelerations. Answer 2 & 4: Uterine rupture and placental abruptions typically present with painful vaginal bleeding. Fetal heart tracing will vary depending on time of presentation, but late decelerations can manifest if maternal hypotension sufficiently compromises the fetal environment. Answer 5: Cord prolapse can present with variable and/or prolonged decelerations on fetal heart monitoring if the prolapse manifests with flow obstruction. Bullet Summary: Placenta previa presents with painless vaginal bleeding in the third trimester, typically following sexual intercourse; fetal heart tracings are usually unremarkable.
4.7
(9)
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