Flashcards in APH Deck (10):
List five risk factors for placenta previa.
Previous placenta previa
Previous CS, especially < 12 months ago
Previous uterine surgery (myomectomy, D&C)
Parity > 3
List three criteria for outpatient management of placenta previa.
No vaginal bleeding
Lives a short distance from the hospital
Transport to hospital readily available
List three ways of managing placental site bleeding at CS.
Oversew placental bed
Injection of vasopressin
List four risk factors for vasa previa.
Velamentous cord insertion (1 in 50) - this is a prerequisite for vasa previa
Bilobate or succenturiate placenta
Placenta previa or low-lying placenta
Fetal anomalies - renal, SUA, NTD
Define vasa previa.
Umbilical blood vessels (unsupported by umbilical cord or placenta) traverse the membranes in the lower uterine segment above the cervix & below the presenting part
Describe the management of vasa previa diagnosed on anatomy scan.
Steroids at 28-32 weeks
Hospitalization at 30-32 weeks
Antenatal peds consult
Serial TV US to assess for possible regression of vasa previa
CS at 35-36 weeks (or immediately following onset of labour/PPROM)
For a woman with a placenta previa or low-lying placenta on second trimester US, at what gestational age does US best predict likelihood of safe vaginal delivery?
You admit a hemodynamically stable woman with bleeding from a placenta previa at 24 weeks. Her bleeding resolves and you prepare to discharge her. She asks whether her single episode of bleeding means she is more likely to deliver significantly preterm. What would you counsel her?
Clinical outcomes of placenta previa are highly variable, can't be confidently predicted
Approx 75% of women experience at least one episode of bleeding (median GA 29 weeks), majority remain stable (median GA for delivery 36 weeks)
List four ultrasound findings that would lead you to suspect placenta accreta.
Loss of the hypoechogenic space between placenta & myometrium
Bladder line interruption
Presence of placental lacunae
Myometrial thickness < 1 mm