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Self-Assessment Questions

Emergency Medicine

Placenta Previa and Abruptio Placentae: Review Questions

Noelle Rotondo, DO

Dr. Rotondo is an attending physician, York Hospital, York, PA; and an assistant professor, Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA.



Choose the single best answer for each question.



Figure 1

1. A 35-year-old gravida 3, para 2 woman who is 38 weeks pregnant presents to the emergency department (ED) with painless, bright red vaginal bleeding that started 2 hours ago. The bleeding has now stopped. Her vital signs are stable. Past medical history is significant for 2 prior cesarean sections. Which of the following is contraindicated in the acute management of this patient?
  1. Cesarean section
  2. Digital pelvic examination
  3. Fetal cardiotocography
  4. Intravenous (IV) access
  5. Transvaginal or transabdominal ultrasound
Click here to compare your answer.


2. A 25-year-old woman who is approximately 35 weeks pregnant based on her last menstrual period presents to the ED with vaginal bleeding. She has had no prenatal care since her first clinic visit at 10 weeks. Vital signs are stable. On examination, her uterus is soft and nontender. A transabdominal ultrasound is performed (Figure). What is this patient’s most likely diagnosis based on the ultrasound findings?

  1. Abruptio placentae
  2. Cord prolapse
  3. Placenta accreta
  4. Placenta previa
  5. Uterine rupture
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3. Which of the following is a risk factor for placenta previa?

  1. Age < 20 years
  2. Gestational diabetes mellitus
  3. Obesity
  4. Prior cesarean section
  5. Strenuous exercise
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Questions 4 and 5 refer to the following case.
A 39-year-old gravida 4, para 3 woman who is 38 weeks pregnant presents to the ED with painful, bright red vaginal bleeding after falling down 5 stairs. She landed on her buttocks and reports no loss of consciousness. On examination, her uterus is tender and firm. Past medical history is significant for smoking cigarettes. A bedside transvaginal ultrasound is negative for placenta previa. The fetal heart rate is 100 bpm. The patient’s vital signs are blood pressure, 95/60 mm Hg; heart rate, 125 bpm; respiratory rate, 20 breaths/min; and temperature, 98.5°F (37°C). Peripheral access is obtained with 2 large-bore IV lines.

4. What is this patient’s most likely diagnosis?

  1. Cervical polyp
  2. Placental abruption
  3. Preeclampsia
  4. Preterm labor
  5. Vasa previa
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5. What is the next step in this patient’s management?

  1. Administer pain medication and continue serial abdominal examinations
  2. Order a Kleihauer-Betke test
  3. Outpatient follow-up after blood pressure improves with IV fluids
  4. Stabilize the patient and arrange immediate obstetric consultation
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6. Which of the following increases the risk of placental abruption?

  1. Age < 35 years
  2. Gestational diabetes
  3. Previous placental abruption
  4. Strenuous exercise
Click here to compare your answer.
 

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Updated 8/25/08 • nvf