Case Study 7 Antepartum Bleeding

Posted on December 17, 2011 by kenzo Case study from Hospital Antonio Lorena, within the obstetrical service. HPI: 37 yo pregnant female of 32 weeks and 4 days gestation presents to the emergency room because of significant vaginal bleeding over the past hour. The patient also reports some contractions, but denies any continuing abdominal pain. She denies any recent trauma. Past Obsetrical History: -G3 P2002 (3 gestations, 2 full term, 0 pre-term, 0 miscarriages, 2 currently living) -2 previous SVDs (spontaneous vaginal delivery) -Last birth was 9 years ago by SVD, weighed 3800 grams -No previous obstetrical complications or morbidity Past Medical History: None Past Surgical History: None Family History: Unremarkable, no history of twins or multiple gestations Social History: Patient lives with her husband in the Santiago district of Cuzco. Denies any smoking, alcohol or other drug use during her pregnancy. Denies any spousal abuse. Completed elementary school, currently works as a housewife. Low economic status. Current Gestational History: -G3 P2002 -Date of Last Menstration: 4/11/11 -Estimated Date of Delivery: 1/22/12 -Estimated Gestational Age (based on dates): 32 4/7 weeks -No prior antenatal care Physical Exam: Vital Signs: Stable (BP 110/70, P 72) General Appearance: No apparent distress, appeared clinically stable Skin: Elastic, capillary reflex < 2 seconds Uterine Height: 30 cm Fetal Lie: Longitudinal Contractions: Present Fetal Heart Tones: 144 x minute Cervical Exam: Deferred Brief Differential Diagnosis: - Placenta Previa - Placental Abruption - Displacement of Cervical Mucous Plug

- Premature Rupture of Membranes - Cervicitis - Vaginitis/Vulvovaginitis Diagnostic Tests: Transabdominal Ultrasound (see below) Number of Gestations: 1 Lie: Longitudinal Presentation: Cephalic Position: Right Fetal Heart Tones: 144 x minute Fetal Movements: Present Placenta: Total occlusion of internal cervical os Discussion: Based on this patients clinical presentation, placenta previa was suspected and further confirmed by transvaginal ultrasound. Placenta previa is defined as the presence of placental tissue over or adjacent to the cervical os, and can be described within a variety of possibilities:

Total placenta previathe internal os is covered completely by placenta Partial placenta previathe internal os is partially covered by placenta Marginal placenta previathe edge of the placenta is at the margin of the internal os Low-lying placentathe placenta is implanted in the lower uterine segment such that the placental edge does not reach the internal os, but is in close proximity to it Vasa previathe fetal vessels course through membranes and present at the cervical os