A 35 year old G5P4 Asian woman with 3 prior C-sections at 34 weeks gestation presents with painless vaginal bleeding. She has no contractions, no pain, no loss of fluid, and fetal movement is present. Challenge: You get sterile gloves for your digital vaginal exam when your resident comes up to you and says, "Stop! She might have a..." What?
Image is in the public domain.
Image is in the public domain.
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5 comments:
Placenta previa
placenta previa
dude, what's with the minivan?
Placenta previa! Nice car!
placenta previa? basing diagnosis on car rather than clinical story
hahahaha yes I like this pun.
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Name That Car
The car shown is the Toyota Previa; this is indeed placenta previa, placental tissue overlying or proximate to the internal cervical os. Risk factors include increasing number of C-sections, increasing parity, increasing maternal age, prior curettages, maternal smoking, residence at high altitudes, multiple gestation, male fetus, early gestational age, and certain races. There is an association with placenta accreta, malpresentation, PPROM, IUGR, vasa previa and velamentous umbilical cord, congenital anomalies, and amniotic fluid embolism. The DDX of third trimester bleeding includes abruption and placenta previa. Ultrasound should be done before digital vaginal exam.
Sources: UpToDate; Wikipedia.
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