Placenta praevia

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Case history

A 38-year-old woman, gravida 5, para 4, and an active smoker, is found to have PP on a routine dating ultrasound at 13 weeks. She returns with painless, bright red vaginal bleeding at 28 weeks. She is not in labour.

Other presentations

Many pregnant women who have PP on ultrasound done for other indications (e.g., early in the second trimester) will on repeat ultrasound have the placenta in normal position.[1][3]Reddy UM, Abuhamad AZ, Levine D, et al. Fetal imaging: executive summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Institute of Ultrasound in Medicine, American College of Obstetricians and Gynecologists, American College of Radiology, Society for Pediatric Radiology, and Society of Radiologists in Ultrasound Fetal Imaging Workshop. J Ultrasound Med. 2014 May;33(5):745-57. Heavy or massive, painless vaginal bleeding in the late second trimester or early third trimester of pregnancy is a highly specific feature suggesting PP. Atypical presentations include vaginal bleeding, usually massive, at the onset of labour at term in a woman with no prior symptoms and whose ultrasound was too early to assess placental position, or painful bleeding due to associated labour or associated placental abruption.

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