patpelletier
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18 yo female G2P1 prenatal visit,10 wks pregnant and last pregnancy complicated by severe contractions and light vaginal bleeding which led to CS at 30 wks. What is her future risk according to her h/x?
A) Stillbirth
B) Placenta Previa
C) PreEclampsia
D) Preterm labor
E) PROM
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| arlete
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D
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| patpelletier
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Thank you. I thought so too. In another thread the answer was P Previa.
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| Ivonne
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Pre-term labor 
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| nany
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isn't this a case of previous abrubtio placents [ uterine contractions + vaginal bleeding ] ?
isn't this a reisk for future Placenta Previa ?
I mean , preterm labor is just preterm labor, without bleeding
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| patpelletier
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So what is your point, I don't understand.
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| nany
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I mean that this patient didn't experience Preterm labor per say, but she experienced Abruptio Placents....., which is a risk for Placenta previa not for preterm labor...
am I right or what?...hope my point is clear
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| nyimalay
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D
contraction+++, bleeding+ means preterm labour.
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| arlete
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Abruptio placenta generally is not light bleeding. Even if the patient has a retroplacental hematoma, she most likelly has hypotension, orthostatics and/or profuse bleeding once the placenta is delivered. The question does not mention anything like that. That's why I think it was premature labor. 
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| nany
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if it was preterm labor in 30 weeks as the question says......then why did they deliver here by CS???
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| farnsworth
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I would go for (B): previous CS increases the risk for placentia praevia (if I remember this right). It increases the risk for uterine rupture, too. But I am not too sure.
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| patpelletier
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So if it was abrubtio what is she at risk for?
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| patpelletier
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A CS is a risk for placenta acreta where villi are invading the myometrium.
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| arlete
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You are right, nany, why would they do a c-section? Maybe it was an abruption placenta!
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| nany
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yyyyyyyyeeeeeeeee
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| farnsworth
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OK, CS is not a risk factor for placenta praevia... So my guess is most probably wrong
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| patpelletier
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Actually, just surfed the web and prior trauma to uterus and CS are in fact risks for previa. So it seems that the answer is previa.
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| dr_arc
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previous csection sounds like a bigger risk than the possible abruption in previous pregnancy. irrrespective of the cause for previous Csectn, the scar on the lower uterus makes her more likely to have a low lying placenta/placenta previa and the risk increases with increasing number of csections in her pregnancy.
a scar on the uterus in one of the worst things to have in a obsetric history.
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| nyimalay
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Yes. I have to change my answer.
Whatever the reason for CS, the scar in uterus is at risk for placenta previa.
Please post the correct answer if any of you have it.
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| nany
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dr_arc wrote:
previous csection sounds like a bigger risk than the possible abruption in previous pregnancy. irrrespective of the cause for previous Csectn, the scar on the lower uterus makes her more likely to have a low lying placenta/placenta previa
agree with that
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| anuba
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I agree w/ nany & dr arc.
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| inkspot
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scar in tissue can lead to premature contraction? but i agree previa should be the answer.
also if i recall it right (from my final yr days) there are two types of CS. one is high and the other is low. and one of them has increase risk of previa.
please some one throw more light on this!
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| arlete
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I think both increase the risk. But the longitudinal one increases more the risk for uterine rupture, and the horizontal one, done over the inferior segment (bikini line) increases more the placenta previa formation.
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| docofthebigapple
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Placenta previa is one of the indications for CS. I do not know if having a CS increases the chances of future Placenta previa.
Having light vaginal bleeding in the thirt trimester would corelate with a patient having a placenta previa that as we understand the lower uterine segment expands and the placental attachment is challenged. Hence the light vaginal bleeding. Having a CS in this situation will also fit in well.
The question asks about future risk. I have an inkling for placenta previa. B
P.S. Classical vertical incision isn't performed anymore thesedays.
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| smal
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http://pregnancy.about.com/cs/placentaprevia/a/pr...
I go with B.
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