Contributor: Peter Bakes, MD

Educational Pearls:

• High concern causes of third trimester vaginal bleeding include placenta previa, placental abruption, or vasa previa
• In placenta previa, the placenta implants over the cervix and this condition
• • Often noted during routine prenatal care on transabdominal ultrasound
• Patients present with painful vaginal bleeding, usually in the absence of trauma
• Avoid pelvic exam, transvaginal ultrasound, or digital vaginal exam in placenta previa
• Risk factors for placenta previa include multiple gestations, previous medical abortions, advanced maternal age, and previous placenta previa
• Management usually includes admission to the hospital
• • >37 weeks: admission for c-section
  • 34-37 weeks: judgment call based on maternal/fetal stability
  • <34 weeks: steroids for fetal lung maturation and delay delivery

References

Anderson-Bagga FM, Sze A. Placenta Previa. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539818/

Young JS, White LM. Vaginal Bleeding in Late Pregnancy. Emerg Med Clin North Am. 2019;37(2):251-264. doi:10.1016/j.emc.2019.01.006

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

*Image from BruceBlaus via Wikimedia Commons licensed under Creative Commons license

The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

Donate to EMM today!