NM706- Exam one
What is the definition of placental abruption? - answer Premature separation (before
completion of the 2nd stage of labor) of placenta away from uterine wall after 20 weeks
What are the risk factors for placental abruption? - answer-Health hx (behaviors and
past OB events)- smoking, cocaine use during pregnancy, AMA <35yo, HTN, and hx of
placental abruption in prior preg
-Current pregnancy- multiple gestation, polyhydramnios, pre-e, sudden uterine
decompression, and short umbilical cord
-Unexpected trauma- MVA, fall, or violence resulting in a blow to the abdomen
What are the signs and symptoms of placental abruption? - answerSevere abdominal
pain, vaginal blood, EFM-tachycardia and non-reassuring FHTs
Class 0: Asymptomatic
· Discovery of a blood clot on the maternal side of a delivered placenta
· Diagnosis is made retrospectively
Class 1: Mild
· No sign of vaginal bleeding or a small amount of vaginal bleeding.
· Slight uterine tenderness
· Maternal blood pressure and heart rate WNL
· No signs of fetal distress
Class 2: Moderate
· No sign of vaginal bleeding to a moderate amount of vaginal bleeding
· Significant uterine tenderness with tetanic contractions
· Change in vital signs: maternal tachycardia, orthostatic changes in blood pressure.
· Evidence of fetal distress
· Clotting profile alteration: hypofibrinogenemia
Class 3: Severe
· No sign of vaginal bleeding to heavy vaginal bleeding
· Tetanic uterus/ board-like consistency on palpation
· Maternal shock
· Clotting profile alteration: hypofibrinogenemia and coagulopathy
· Fetal death
**Classification of 0 or 1 is usually associated with a partial, marginal separation;
whereas, classification of 2 or 3 is associated with complete or central separation.
o What testing or imaging is available to diagnose placental abruption? - answerU/S
may be helpful but is not able to see abruption until more severe, BPP may be done to
determine fetal wellbeing <6 requires c/s, abruption may only be dx truly after delivery-
may have clot on maternal side
, o How should placental abruption be managed? - answerIV fluids and supplemental O2,
as well as continuous maternal and fetal monitoring, if only class 0-1, may be managed
conservatively, if class 2-3 delivery should be immediate (maybe be possible for vaginal
but if necessary c/s), cross/matched, 2 large-bore, and NICU team should be present
for fetal resus.
o What is the definition of placenta previa? - answerComplete or partial covering of the
internal os of the cervix with the placenta
o What are the risk factors for placenta previa? - answerRisk factors: hx of placenta
previa, hx of AMA, multiparity, smoking, hx of curettage, use of cocaine, multiple
placentas (di-di twins), and hx of c/s
Major risk factor for PPH, and can lead to morbidity and mortality of the mother and
neonate- prevents safe vaginal delivery and must be done via c/s
Places pt at higher risk for accrete spectrum
o What are the signs and symptoms of placenta previa? - answerPainless vaginal
bleeding, esp in 2/3rd trimester
o What testing or imaging is available to diagnose placenta previa? - answerDx early in
pregnancy via sonography (transabdominal to r/o before digital SVE, transvaginal too
confirm location of the placenta), and others may present to the ER in the 2nd/3rd
trimester for painless vaginal bleeding
o How should placenta previa be managed? - answerElective c/s at 36-37 weeks, if they
present w/ vaginal bleeding before should have VS and EFM done immediately, 2 large
bore IVs with CBC, type/screen, and coags; if bleeding is substantial, blood should be
crossed and matched; if bleeding is substantial, should be delivered no matter what
gestation, over 36wks with any bleeding should be delivered
o What is the definition of vasa previa? - answerVessels travel within the membranes
and overlie the cervical os
o How is vasa previa diagnosed? - answerAn examiner is occasionally able to palpate
or directly see tubular fetal vessels in the membranes overlying the presenting part, may
be see by U/S during midtrimester scan, or via transvaginal sonography
o How should vasa previa be managed? - answerOnce identified, subsequent imagining
to determine severity and if improving, antenatal corticosteroids and antenatal
hospitalization at 30-34 weeks if expedited delivery is expected- scheduled c/s delivery
with an OB at 34-37 weeks
o What are the signs and symptoms of retained placenta? - answerPlacenta remains in
the uterus at 30 minutes pp
What is the definition of placental abruption? - answer Premature separation (before
completion of the 2nd stage of labor) of placenta away from uterine wall after 20 weeks
What are the risk factors for placental abruption? - answer-Health hx (behaviors and
past OB events)- smoking, cocaine use during pregnancy, AMA <35yo, HTN, and hx of
placental abruption in prior preg
-Current pregnancy- multiple gestation, polyhydramnios, pre-e, sudden uterine
decompression, and short umbilical cord
-Unexpected trauma- MVA, fall, or violence resulting in a blow to the abdomen
What are the signs and symptoms of placental abruption? - answerSevere abdominal
pain, vaginal blood, EFM-tachycardia and non-reassuring FHTs
Class 0: Asymptomatic
· Discovery of a blood clot on the maternal side of a delivered placenta
· Diagnosis is made retrospectively
Class 1: Mild
· No sign of vaginal bleeding or a small amount of vaginal bleeding.
· Slight uterine tenderness
· Maternal blood pressure and heart rate WNL
· No signs of fetal distress
Class 2: Moderate
· No sign of vaginal bleeding to a moderate amount of vaginal bleeding
· Significant uterine tenderness with tetanic contractions
· Change in vital signs: maternal tachycardia, orthostatic changes in blood pressure.
· Evidence of fetal distress
· Clotting profile alteration: hypofibrinogenemia
Class 3: Severe
· No sign of vaginal bleeding to heavy vaginal bleeding
· Tetanic uterus/ board-like consistency on palpation
· Maternal shock
· Clotting profile alteration: hypofibrinogenemia and coagulopathy
· Fetal death
**Classification of 0 or 1 is usually associated with a partial, marginal separation;
whereas, classification of 2 or 3 is associated with complete or central separation.
o What testing or imaging is available to diagnose placental abruption? - answerU/S
may be helpful but is not able to see abruption until more severe, BPP may be done to
determine fetal wellbeing <6 requires c/s, abruption may only be dx truly after delivery-
may have clot on maternal side
, o How should placental abruption be managed? - answerIV fluids and supplemental O2,
as well as continuous maternal and fetal monitoring, if only class 0-1, may be managed
conservatively, if class 2-3 delivery should be immediate (maybe be possible for vaginal
but if necessary c/s), cross/matched, 2 large-bore, and NICU team should be present
for fetal resus.
o What is the definition of placenta previa? - answerComplete or partial covering of the
internal os of the cervix with the placenta
o What are the risk factors for placenta previa? - answerRisk factors: hx of placenta
previa, hx of AMA, multiparity, smoking, hx of curettage, use of cocaine, multiple
placentas (di-di twins), and hx of c/s
Major risk factor for PPH, and can lead to morbidity and mortality of the mother and
neonate- prevents safe vaginal delivery and must be done via c/s
Places pt at higher risk for accrete spectrum
o What are the signs and symptoms of placenta previa? - answerPainless vaginal
bleeding, esp in 2/3rd trimester
o What testing or imaging is available to diagnose placenta previa? - answerDx early in
pregnancy via sonography (transabdominal to r/o before digital SVE, transvaginal too
confirm location of the placenta), and others may present to the ER in the 2nd/3rd
trimester for painless vaginal bleeding
o How should placenta previa be managed? - answerElective c/s at 36-37 weeks, if they
present w/ vaginal bleeding before should have VS and EFM done immediately, 2 large
bore IVs with CBC, type/screen, and coags; if bleeding is substantial, blood should be
crossed and matched; if bleeding is substantial, should be delivered no matter what
gestation, over 36wks with any bleeding should be delivered
o What is the definition of vasa previa? - answerVessels travel within the membranes
and overlie the cervical os
o How is vasa previa diagnosed? - answerAn examiner is occasionally able to palpate
or directly see tubular fetal vessels in the membranes overlying the presenting part, may
be see by U/S during midtrimester scan, or via transvaginal sonography
o How should vasa previa be managed? - answerOnce identified, subsequent imagining
to determine severity and if improving, antenatal corticosteroids and antenatal
hospitalization at 30-34 weeks if expedited delivery is expected- scheduled c/s delivery
with an OB at 34-37 weeks
o What are the signs and symptoms of retained placenta? - answerPlacenta remains in
the uterus at 30 minutes pp
