Placenta Previa in Emergency Medicine Clinical Presentation

  • Author: Patrick Ko, MD; Chief Editor: Pamela L Dyne, MD   more...
 
Updated: Apr 4, 2011
 

History

Placenta previa is one of the leading causes of vaginal bleeding.

  • Vaginal bleeding is apt to occur suddenly during the third trimester.
  • Bleeding is usually bright red and painless. Some degree of uterine irritability is present in about 20% of the cases.
  • Initial bleeding is not usually profuse enough to cause death; it spontaneously ceases, only to recur later.
  • The first bleed occurs (on average) at 27-32 weeks' gestation.
  • Contractions may or may not occur simultaneously with the bleeding.
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Physical

  • Profuse hemorrhage
  • Hypotension
  • Tachycardia
  • Soft and nontender uterus
  • Normal fetal heart tones (usually)
  • Vaginal and rectal examinations: Do not perform these examinations in the ED because they may provoke uncontrollable bleeding. Perform examinations in the operating room under double set-up conditions (ie, ready for emergent cesarean delivery).
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Causes

Prior uterine insult or injury is a cause.

Risk factors include the following:

  • Prior placenta previa (4-8%)
  • First subsequent pregnancy following a cesarean delivery
  • Multiparity (5% in grand multiparous patients)
  • Advanced maternal age
  • Multiple gestations
  • Prior induced abortion
  • Smoking
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Contributor Information and Disclosures
Author

Patrick Ko, MD  Clinical Assistant Professor, Department of Emergency Medicine, New York University Medical School; Assistant Program Director, Department of Emergency Medicine, North Shore University Hospital

Patrick Ko, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Young Yoon, MD  Associate Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center

Young Yoon, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Mark Zwanger, MD, MBA  Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References

  1. Vergani P, Ornaghi S, Pozzi I, Beretta P, Russo FM, Follesa I, et al. Placenta previa: distance to internal os and mode of delivery. Am J Obstet Gynecol. Jul 23 2009;[Medline].

  2. Milosevic J, Lilic V, Tasic M, Radovic-Janosevic D, Stefanovic M, Antic V. [Placental complications after a previous cesarean section]. Med Pregl. May-Jun 2009;62(5-6):212-6. [Medline].

  3. [Guideline] Royal College of Obstetricians and Gynaecologists (RCOG). Placenta praevia and placenta praevia accreta: diagnosis and management. Oct 2005;[Full Text].

  4. [Guideline] Oppenheimer L. Diagnosis and management of placenta previa. J Obstet Gynaecol Can. Mar 2007;29(3):261-73. [Medline]. [Full Text].

  5. Ananth CV, Smulian JC, Vintzileos AM. The effect of placenta previa on neonatal mortality: a population-based study in the United States, 1989 through 1997. Am J Obstet Gynecol. May 2003;188(5):1299-304. [Medline].

  6. Besinger RE, Moniak CW, Paskiewicz LS, Fisher SG, Tomich PG. The effect of tocolytic use in the management of symptomatic placenta previa. Am J Obstet Gynecol. Jun 1995;172(6):1770-5; discussion 1775-8. [Medline].

  7. Crane S, Chun B, Acker D. Treatment of obstetrical hemorrhagic emergencies. Curr Opin Obstet Gynecol. Oct 1993;5(5):675-82. [Medline].

  8. Dola CP, Garite TJ, Dowling DD, Friend D, Ahdoot D, Asrat T. Placenta previa: does its type affect pregnancy outcome?. Am J Perinatol. Oct 2003;20(7):353-60. [Medline].

  9. Gidiri M, Noble W, Rafique Z, Patil K, Lindow SW. Caesarean section for placenta praevia complicated by postpartum haemorrhage managed successfully with recombinant activated human coagulation Factor VIIa. J Obstet Gynaecol. Nov 2004;24(8):925-6. [Medline].

  10. Glynn JC, Plaat F. Prothrombin complex for massive obstetric haemorrhage. Anaesthesia. Feb 2007;62(2):202-3. [Medline].

  11. Iyasu S, Saftlas AK, Rowley DL, Koonin LM, Lawson HW, Atrash HK. The epidemiology of placenta previa in the United States, 1979 through 1987. Am J Obstet Gynecol. May 1993;168(5):1424-9. [Medline].

  12. Otsubo Y, Shinagawa T, Chihara H, Araki T. Conservative management of a case of placenta praevia percreta. Aust N Z J Obstet Gynaecol. Nov 1999;39(4):518-9. [Medline].

  13. Rani PR, Haritha PH, Gowri R. Comparative study of transperineal and transabdominal sonography in the diagnosis of placenta previa. J Obstet Gynaecol Res. Apr 2007;33(2):134-7. [Medline].

  14. Rathore SS, McMahon MJ. Racial variation in the frequency of intrapartum hemorrhage. Obstet Gynecol. Feb 2001;97(2):178-83. [Medline].

  15. Sharma A, Suri V, Gupta I. Tocolytic therapy in conservative management of symptomatic placenta previa. Int J Gynaecol Obstet. Feb 2004;84(2):109-13. [Medline].

  16. Smith RS, Lauria MR, Comstock CH, Treadwell MC, Kirk JS, Lee W, et al. Transvaginal ultrasonography for all placentas that appear to be low-lying or over the internal cervical os. Ultrasound Obstet Gynecol. Jan 1997;9(1):22-4. [Medline].

  17. Taber. Manual of Gynecologic and Obstetric Emergencies. 2nd ed. Philadelphia, Pa: WB Saunders Co; 1984:313-318.

  18. Taylor VM, Peacock S, Kramer MD, Vaughan TL. Increased risk of placenta previa among women of Asian origin. Obstet Gynecol. Nov 1995;86(5):805-8. [Medline].

  19. Timor-Tritsch IE, Monteagudo A. Diagnosis of placenta previa by transvaginal sonography. Ann Med. Jun 1993;25(3):279-83. [Medline].

  20. Williams, Cunningham, Macdonald. Williams' Obstetrics. 19th ed. Norwalk, Conn: Appleton & Lange; 1993:836-841.

  21. Zhang J, Savitz DA. Maternal age and placenta previa: a population-based, case-control study. Am J Obstet Gynecol. Feb 1993;168(2):641-5. [Medline].

 
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