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Old 10-24-2012
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ObGyn Placenta Previa question

A 23-year-old G3P2 woman at 29 weeks’ gestation presents to the emergency department complaining of 2 hours of vaginal bleeding. She denies any abdominal pain, cramping, or contractions associated with the bleeding. She has a history of placenta previa but has had poor prenatal care for this pregnancy. Her temperature is 37.1°C (98.8°F), blood pressure is 125/84 mm Hg, pulse is 86/min, and respiratory rate is 18/min. Fetal heart monitoring is reassuring, with a heart rate of 155/min, variable accelerations, and no decelerations.

Whats the best next diagnostic workup?

a. transvaginal ultrasound
b. transabdominal ultrasound
c. CT
d. MRI
e. C-section
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Old 10-24-2012
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B)
You start with Trans abdominal USG and if equivocal or negative and you still have a good suspicion of PP then go on toward A)

However one must be extracareful because in PP both vaginal examination and transvaginal USG carry a lot of risk of rupturing and hemorrhage.

Also one must counsel the patient to avoid Vaginal sex, so she can try other options like anal, oral and foreplay!

Last edited by XpaezX; 10-24-2012 at 07:50 AM.
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Old 10-24-2012
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Rx says A is the right one...
I am totally agree with you XpaezX though...
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Old 10-24-2012
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Quote:
Originally Posted by DocSikorski View Post
Rx says A is the right one...
I am totally agree with you XpaezX though...

Rx is wrong then, both Uworld and kaplan qbank have similar questions testing almost exactly the same concept with almost exactly the same options.. all of them agree that you start with TA USG to see exactly where the placenta lies, if it s marginal or incomplete THEN transvaginal USG can be done if done by an expert because the transducer is within 2-3 cms of the cervical os.

MTB 2 Placenta Previa section also states that same fact..
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Old 10-24-2012
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agreed .......
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