Emergency medicine residents and new residency graduates preparing for oral board examinations.
Placenta previa is a serious cause of vaginal bleeding in the second half of pregnancy that can have potentially life-threatening effects including maternal or fetal hemorrhage, distress or death of the fetus.
By the end of this oral boards case, the learner will be able to:
- List the potential causes of vaginal bleeding in pregnancy after 20 weeks including placental abruption, placenta previa and vasa previa.
- Describe the bedside stabilization and evaluation in a pregnant patient with vaginal bleeding after 20 weeks.
- Stabilize the mother (patient) including placing two large bore intravenous (IV) lines, administer an IV fluid bolus, obtaining complete blood count (CBC), coagulation studies, and type & cross matching blood.
- Transvaginal ultrasound to determine the placental location.
- Sterile speculum examination. A digital or speculum pelvic examination should NOT be performed until a transvaginal ultrasound is performed to determine placental location. The resident should understand that performing a digital or speculum exam in a patient with placenta previa or vasa previa can cause or exacerbate hemorrhage. If these two conditions are not present on ultrasound, then a sterile speculum exam may be performed to further examine the bleeding.
- Contrast the typical presentation of placenta previa with that of placental abruption.
- Placenta Previa usually causes painless vaginal bleeding. Part of the placenta is located near or over the internal cervical orifice.
- Placental Abruption usually causes painful vaginal bleeding. There is premature separation of the placenta from the uterine lining.
- Describe the appropriate disposition of a patient with a pregnancy over 20 weeks with vaginal bleeding. After initial workup and stabilization these women are usually admitted for fetal monitoring, observation and consultation by the obstetrician (OB/gyn).
Oral boards case
Vaginal bleeding, pregnancy complications, placental abruption, placenta previa, vasa previa, OB/gyn, obstetrics.