Placental Abruption


-Placental abruption (also referred to as abruptio placentae) refers to partial or complete placental detachment prior to delivery of the fetus.

-The immediate cause is rupture of maternal blood vessels in the decidua basalis.

-Risk factors: previous abruption, cocaine use, smoking, hypertension, uterine anomalies,

-Classic Symptoms and Signs: vaginal bleeding, abdominal pain, contractions, uterine  tenderness, a nonreassuring fetal heart rate (FHR) tracing

-Severe abruption can lead to Disseminated Intravascular Coagulation (DIC).

-Classic Ultrasound Finding: Identification of a Retroplacental Hematoma/blood clot.


Fetal heart rate nonreassuring, vaginal delivery or C-section.

Fetal heart rate is reassuring but mother unstable: vaginal delivery or C-section.

Mother & Fetus stable, less than 34 weeks gestation: conservative management

Mother & Fetus stable, at 34 – 36 weeks gestation: delivery

Placenta Previa

-One to 6 percent pregnant women presents with ultrasound evidence of a placenta previa between 10 and 20 weeks of gestation. 90 percent of these early cases resolve.

-The characteristic symptom: Painless vaginal bleeding.

-Major risk factors: Previous placenta previa, previous cesarean delivery, multiple gestation, increasing maternal age, increasing parity, maternal smoking, cocaine use, infertility treatment.

-Placenta previa should be suspected in any woman beyond 20 weeks of gestation who presents with vaginal bleeding.

-Diagnosis is based on identification of placental tissue over the internal cervical os on ultrasound.

-Asymptomatic women: determine whether the previa resolves with increasing gestational age.  Follow-up transvaginal ultrasonography is performed at 32 weeks of gestation and again at 36 weeks if the placenta remains over or <2 cm from the internal os

-If previa persists at 36+0 to 37+6 weeks of gestation, perform cesarean delivery.

Ectopic Pregnancy

-An ectopic pregnancy is an extrauterine pregnancy. Almost all ectopic pregnancies occur in the fallopian tube (96 percent), but other possible sites include cervical, interstitial, hysterotomy (cesarean) scar, ovarian, or abdominal.

-Most common symptoms: Abdominal pain and vaginal bleeding

-Evaluate with Transvaginal Ultrasound (TVUS) and quantitative hCG level. Measure hCG serially every two to three days.

-The diagnosis of ectopic pregnancy is a clinical diagnosis made based upon serial hCG testing and TVUS

-Do not depend on a single hCG result to diagnose ectopic pregnancy.

-hCG discriminatory zone: It is the serum hCG level above which a gestational sac should be visualized by Ultrasound if an intrauterine pregnancy is present. It is around 2000 IU/Liter.

-If the serial hCG is rising abnormally and is below the discriminatory zone, the diagnosis is made based upon hCG levels.

-If the hCG is above the discriminatory zone, the diagnosis is made using ultrasound findings (gestational sac with a yolk sac or embryo)