Monday, January 20, 2014

A Single Drop

A 35 year old G5P1 woman currently pregnant with a 32 week fetus through IVF presents for a routine obstetric visit. Her obstetric history is only significant for a second-trimester low-lying placenta. A transvaginal ultrasound is shown below:

Note the posterior placenta with a linear sonolucent area with color flow Doppler. You admit the patient, give betamethasone and perform frequent fetal heart monitoring. You make a plan to deliver the fetus by emergency C-section if the patient goes into labor, premature rupture of membranes, repetitive variable decelerations refractory to tocolysis, or vaginal bleeding accompanied by fetal heart rate changes. You schedule a C-section at 36 weeks.

Challenge: What's the diagnosis?

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1 comment:

Craig Chen said...

A Single Drop

This is vasa previa where fetal blood vessels are present in the membranes covering the internal cervical os. The concern is that spontaneous or artificial rupture of membranes can cause rupture of the vasa previa and fetal hemorrhage. There is no consensus on best management of these patients.

Source: UpToDate.