OBSTETRICS AND GYNECOLOGY■ Fetus distress is suggested by: HR <120, or >160, decelerations after uter-
ine irritability, or loss of beat-to-beat variability during continuous fetal
monitoring.
■ Emergent OB consultation should be obtained for assistance with moni-
toring and possible delivery in patients with suspected abruption.
■ Rh isoimmunization prophylaxis as needed.
Placenta Previa
Placenta previa occurs when the placenta overlaps and implants on the cervix,
covering the internal os to varying degrees.
Risk factors include previous placenta previa as well as any pathology that
changes the inner surface of the uterus:
■ Prior C-section
■ Multiple gestations
■ Multiple induced abortions
■ Advanced maternal age
SYMPTOMS
Painless, bright red vaginal bleeding
EXAM
■ Abdominal exam reveals a soft, nontender uterus.
■ Do not perform a pelvic exam.
■ An obstetrician should be consulted prior to pelvic examination in the set-
ting of third trimester bleeding because if placenta previa is present, severe
hemorrhage may result.
DIFFERENTIAL
Placental abruption vs rupture of membranes
DIAGNOSIS
■ Transabdominal ultrasoundis the key to the diagnosis!
■ The ultrasound will show the placental location.
■ This is in contrast to abruption, which cannot always be seen on ultrasound.
TREATMENT
■ Emergent OB consult for maternal/fetal monitoring.
■ Do not encourage vaginal delivery in a patient with placenta previa; most
cases require C-section.
■ Rh-isoimmunization prophylaxis as needed.
Premature Rupture of Membranes
Defined as rupture of membranes prior to the onset of labor. Preterm prema-
ture rupture of membranes (PPROM) refers to rupture of membranes occur-
ring prior to labor in a patient <37 weeks gestation.
SYMPTOMS
Rush of fluid or a continuous leak of fluid from the vagina
Painless, bright red, third
trimester vaginal bleeding =
placenta previa.Do not perform pelvic exam
on patients with third
trimester vaginal bleeding.