Doc750
transfer:step 3 prison
Topics: 52
Posts: 634
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A 36 yr old G5P4 woman at 27 weeks gestation presents to her obstetrician complaining of vaginal bleeding. She states that the bleeding began 2 days ago as mild pinkish spotting but has recently worsened. She denies any abdominal or pelvic pain with the bleeding and states that she has not experienced any trauma. She has no medical problems except for a history of preeclampsia in a previous pregnancy, which necessitated an emergent c-section. Vital signs are notable for a temperature of 99.2 degrees F, HR of 90/min, and a BP of 105/70 mm Hg. PE is notable for gravid uterus with size equal to dates and a closed internal os.
1) What is the most likely diagnosis?
2) What are risk factors for this condition?
3) How is this condition diagnosed?
4) What is the other most common cause of antepartum hemorrhage?
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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| me007
Forum Guru
Topics: 72
Posts: 799
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1. placenta previa
2. prior C-section
3. ultrasonography
4. abruptio placenta, vasa previa
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| Doc750
transfer:step 3 prison
Topics: 52
Posts: 634
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1. Dx = Placenta previa
2. Risk factors = Advanced maternal age, multiparity, multifetal gestation, a prior c-section, smoking
3. Dx: clinical hx and US. DO NOT perform pelvic exam in an attempt to palpate the placenta
4. Other MCC of antepartum hemorrhage = Placental abruption (premature seperation of the normally implanted placenta). In contrast to the painless bleeding assoc. with placenta previa, a placental abruption is usually painful.
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Experience is a hard teacher because she gives the test first, and the lesson afterwards.
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