A 20yo pregnant 32wks by date presents to the antenatal clinic with hx of painless vaginal
bleeding after intercourse. Exam: P/A – soft and relaxed, uterus=dates, CTG=reactive. Choose
the single most likely dx?
a. Abruption of placenta 2nd to pre-eclampsia
b. Antepartum hemorrhage
c. Placenta previa
d. Preterm labor
e. Placenta percreta
answer: C
Placenta Previa
• PAINLESS bright red vaginal bleeding (recurrent), may be minimized and cease spontaneously, but can become catastrophic
• mean onset of bleeding is 30 wk GA, but onset depends on degree of previa
• physical exam
uterus soft and non-tender
presenting fetal part high or displaced
FHR usually normal
shock/anemia correspond to degree of apparent blood loss
Abruption = PAINFUL bleed
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