| October 2006 · Vol. 18, No. 10 Obstetric Emergencies
Diagnosis and safe management of placenta previa
As repeat cesareans increase, so do placental abnormalities
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Fast Track
The mean gestational age at the time of the first episode of vaginal bleeding is 29 to 32 weeks
Accurate diagnosis may be difficult if the uterus is contracting during ultrasound imaging
In women with placenta previa, the risk of placenta accreta was 67% after 4 prior cesarean deliveries
Immediate cesarean delivery is indicated for bleeding at term and life-threatening hemorrhage
Rehospitalize women with recurrent vaginal bleeding during outpatient management
If there is strong evidence of accreta or percreta at the time of delivery, leave the placenta in situ and perform hysterectomy
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Chi
P.
Dola,
MD, MPH;
Associate Professor and Associate, Residency Program Director, Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Tulane School of Medicine, New Orleans Sherri
A.
Longo,
MDMaternal-Fetal Medicine Specialist, Section of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Clinic Foundation, New Orleans
CASE Diagnosis precedes sentinel episode of bleeding
“G.A.” is a 39-year-old gravida 6, para 1041 who was diagnosed with complete placenta previa during a target ultrasound exam performed at 18 weeks for advanced maternal age. She had a sentinel episode of vaginal bleeding at 29 weeks and was hospitalized for close monitoring.
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