obs!!! - mos11

[ArchivalUser]

14.5 An 18-year-old adolescent female is noted to have a marginal placenta
previa on an ultrasound examination at 22 weeks™ gestation. She does
not have vaginal bleeding or spotting. Which of the following is the
most appropriate management?
A. Schedule cesarean delivery at 39 weeks.
B. Schedule an amniocentesis at 36 weeks and deliver by cesarean if
the fetal lungs are mature.
C. Schedule an MRI examination at 35 weeks to assess for possible
percreta involving the bladder.
D. Reassess placental position at 34 to 35 weeks™ gestation by ultrasound.
E. Recommend termination of pregnancy

[ArchivalUser]

DDD placenta can migrate during next weeks and return to normal position

[ArchivalUser]

ddddddd

[ArchivalUser]

dd

[ArchivalUser]

D)Very often, a marginal or low-lying placenta previa at the early
second trimester will resolve by transmigration of the placenta. It is
too early to discuss scheduling a cesarean delivery since the placenta
previa may resolve and allow for vaginal delivery. At 35 weeks, an
ultrasound should be repeated to see whether or not the placenta has
migrated. There would be no reason to be concerned about a percreta
if the placenta migrates to a more favorable position; therefore
scheduling an MRI is not indicated at this time. In addition, an MRI
is expensive and only 38% sensitive. If there is suspicion that a percreta
exists, a previa has most likely already been diagnosed in the late
second trimester or third trimester, so a scheduled cesarean delivery
would most likely already be in the plan. During the cesarean, the
physician will be able to assess the extent of the previa and base
management on how far the placenta has penetrated through the
uterine wall. Placenta percreta and increta are usually diagnosed during
a cesarean delivery and not radiographically. Again, it would be too
early to schedule for an amniocentesis at 36 weeks since the placenta
has a chance of transmigrating. Recommending termination of pregnancy
would be inappropriate in this case. Even if the patient has a
placenta previa at the time of delivery, both the mother and baby
have an excellent prognosis if a cesarean delivery is performed