OB Question

[juxtin1987]

How do you, as a basic, diagnose or recognize placenta previa without insertion of the vagina?
Or is it more of a "I dont see the head, recovery position go go"?

 

[triemal04]

How do you, as a basic, diagnose or recognize placenta previa without insertion of the vagina?
Or is it more of a "I dont see the head, recovery position go go"?

Most likely time you'll see placenta previa (if it's unknown anyway) in the field isn't during childbirth but because the woman has vaginal bleeding. To be finicky, you can't completely definitively diagnose it in the field, but you should be able to come close enough that that doesn't matter. Bright red, painless, possible profuse bleeding later in the pregnancy without a readily discernible cause...call it placenta previa and go.
http://emedicine.medscape.com/article/796182-overview

 

[juxtin1987]

Thanks alot, also is previa diagnosable via ultrasound in early term? i guess i didn't consider the idea that the patient may be aware of their condition.

 

[triemal04]

Thanks alot, also is previa diagnosable via ultrasound in early term? i guess i didn't consider the idea that the patient may be aware of their condition.

I don't know for certain. I'd guess that ultrasound would be how it was discovered but can't say for sure. The last time I can remember seeing it in the field the lady knew she had it, though it may not have been total when it was found.

 

[Lifeguards For Life]

Thanks alot, also is previa diagnosable via ultrasound in early term? i guess i didn't consider the idea that the patient may be aware of their condition.

Placenta previa may be diagnosed via ultrasound in the mothers second trimester, most commonly near 20 weeks gestation.

 

[Lifeguards For Life]

How do you, as a basic, diagnose or recognize placenta previa without insertion of the vagina?
Or is it more of a "I dont see the head, recovery position go go"?

What signs/symptoms are you anticipating that would be indicative of placenta previa?

Painless, bright red vaginal bleeding in the second half of pregnancy is the hallmark of placenta previa. This complication often corrects itself by the end of pregnancy.

If placenta previa is still present when it is time for the baby to be born a cesarean section is required

Though all vaginal bleeding in any female of child baring age should be treated as a medical emergency.

Bright red blood not un similiar to that found in placenta previa can be indicative of an impending abortion.

And of course, as taught in basic classes the world over,"Treat all abdominal pain or vaginal bleeding as an ectopic pregnancy, untill proven otherwise."

Take care,
L4L

 

[LucidResq]

You aren't likely to see previa on ultrasound until you're well in to the second trimester, most likely the third. It is difficult to ascertain the exact position of the placenta early in pregnancy on ultrasound.

Spotting in early pregnancy is fairly common in the first few weeks of pregnancy, often in the time period the woman doesn't even know she is pregnant or has just discovered so. After that it can be a cause for concern. Keep in mind spontaneous abortion is more common than most realize and when you're talking the first trimester, an extremely likely cause.

 

[juxtin1987]

Though all vaginal bleeding in any female of child baring age should be treated as a medical emergency.

Bright red blood not un similiar to that found in placenta previa can be indicative of an impending abortion.

And of course, as taught in basic classes the world over,"Treat all abdominal pain or vaginal bleeding as an ectopic pregnancy, untill proven otherwise."

Take care,
L4L

I was thinking about this a bit last night and would appreciate some clarification. The way i read the text (Keep in mind I'm very green to all of this) ectopic pregnancy wouldn't progress to say second or third trimester, so the way i'm reading your statement i'm to assume that bleeding or abd pain in a Female of Child baring age is to be considered ectopic, does this include a Pt who's in later stages of pregnancy or is it to be assumed as previa at that point? Also, another question regarding OB, when a Pt is experiencing Abruptio, is that ALWAYS seen as a postpartum presentation or can abruptio occur prior to delivery of the child?

I know for Prehospital care purposes that it doesn't necessarily matter why they're bleeding (Especially for a basic) and that the transport decision and care rendered will likely be the same, but as i've suggested in previous posts, i'm the type of person that just likes to know =P

Any Help is Much Appreciated

-JC

 

[Lifeguards For Life]

I was thinking about this a bit last night and would appreciate some clarification. The way i read the text (Keep in mind I'm very green to all of this) ectopic pregnancy wouldn't progress to say second or third trimester, so the way i'm reading your statement i'm to assume that bleeding or abd pain in a Female of Child baring age is to be considered ectopic, does this include a Pt who's in later stages of pregnancy or is it to be assumed as previa at that point? Also, another question regarding OB, when a Pt is experiencing Abruptio, is that ALWAYS seen as a postpartum presentation or can abruptio occur prior to delivery of the child?

I know for Prehospital care purposes that it doesn't necessarily matter why they're bleeding (Especially for a basic) and that the transport decision and care rendered will likely be the same, but as i've suggested in previous posts, i'm the type of person that just likes to know =P

Any Help is Much Appreciated

-JC

Natural progression of ectopic pregnancy usually arrests spontaneously with tubal rupture, tubal abortion, spontaneous resolution or the development of chronicity. Surgical intervention by means of a salpingectomy or a salpingostomy accounts for most others. Advanced ectopic pregnancy is therefore very rare and often associated with diagnostic error.

Most extra-uterine pregnancies are diagnosed in the first trimester and treated using surgical, medical, expectant, or combined strategies. Ectopic pregnancies diagnosed in the second trimester are very rare.

Although rare it is possible for an ectopic pregnancy to progress to term. Considering ectopic pregnancies occur in about seven of every 1,000 pregnancies in the United States, and only one percent of ectopic pregnancies progress beyond the 6 month mark, it would be an exceedingly rare complication to encounter in the field.

Attached is an article detaling 4 cases of advanced to full term ectopic pregnancies in the last 10 years.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1823771/?page=1

Here is an article pulled from JAMA Backfiles. http://jama.ama-assn.org/cgi/content/summary/80/13/913

Placenta abrutio affects about 9 out of 1,000 pregnancies. It usually occurs in the third trimester, but it can happen at any time after the 20th week of gestation.

Here is a good article on Placenta abruptio. http://www.nlm.nih.gov/medlineplus/ency/article/000901.htm

take care,
L4L

 

[juxtin1987]

Thank You