15/10/2016 PlacentaPreviaDifferentialDiagnoses

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PlacentaPreviaDifferentialDiagnoses
Author:RonanBakker,MDChiefEditor:CarlVSmith,MDmore...

Updated:May12,2016

DiagnosticConsiderations
Instrumentsorfingersshouldnotbeplacednearthecervixduringavaginal
examination,becauseuncontrolledbleedingcanresult.Donotperformvaginalor
rectalexaminationsinanoutpatientoremergencydepartmentsettingunless
ultrasonographyfindingshaveruledoutplacentaprevia.

Rarely,ultrasonographyisunavailableandadigitalexaminationisnecessary.Ifthis
isthecase,thedigitalexaminationshouldbeperformedintheoperatingroom
underdoublesetupconditions(ie,oneteamreadyforemergentcesareandelivery
andoneteamreadyforuneventfulvaginaldelivery).

Otherproblemstoconsiderinawomanwithsuspectedplacentapreviaincludethe
following:

Vasaprevia
Cervicalorvaginallaceration
Vaginalsidewalllaceration
Miscarriage(spontaneousabortion)
Infection
Vaginalbleeding
Lowergenitaltractlesions
Bloodyshow

DifferentialDiagnoses
AbruptioPlacentae

Cervicitis

http://emedicine.medscape.com/article/262063differential 4/7
15/10/2016 PlacentaPreviaDifferentialDiagnoses
DisseminatedIntravascularCoagulation

Pregnancy,Delivery

PrematureRuptureofMembranes

PretermLabor

UterineRuptureinPregnancy

Vaginitis

Vulvovaginitis

Workup

ContributorInformationandDisclosures
Author
RonanBakker,MDResidentPhysician,DepartmentofObstetricsandGynecology,VirginiaCommonwealth
UniversityHealthSystem

RonanBakker,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AmericanMedicalAssociation

Disclosure:Nothingtodisclose.

Coauthor(s)
RonaldMRamus,MDProfessorofObstetricsandGynecology,Director,DivisionofMaternalFetalMedicine,
VirginiaCommonwealthUniversitySchoolofMedicine

RonaldMRamus,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AmericanInstituteofUltrasoundinMedicine,MedicalSocietyofVirginia,SocietyforMaternal
FetalMedicine

Disclosure:Nothingtodisclose.

SpecialtyEditorBoard
JohnGPierce,Jr,MDAssociateProfessor,DepartmentsofObstetrics/GynecologyandInternalMedicine,
MedicalCollegeofVirginiaatVirginiaCommonwealthUniversity

JohnGPierce,Jr,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AssociationofProfessorsofGynecologyandObstetrics,ChristianMedicalandDental
Associations,MedicalSocietyofVirginia,SocietyofLaparoendoscopicSurgeons

Disclosure:Nothingtodisclose.

ChiefEditor
CarlVSmith,MDTheDistinguishedChrisJandMarieAOlsonChairofObstetricsandGynecology,Professor,
DepartmentofObstetricsandGynecology,SeniorAssociateDeanforClinicalAffairs,UniversityofNebraska
MedicalCenter

CarlVSmith,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AmericanInstituteofUltrasoundinMedicine,AssociationofProfessorsofGynecologyand
Obstetrics,CentralAssociationofObstetriciansandGynecologists,SocietyforMaternalFetalMedicine,Council
ofUniversityChairsofObstetricsandGynecology,NebraskaMedicalAssociation

Disclosure:Nothingtodisclose.

AdditionalContributors
SajuJoy,MD,MSAssociateDirector,DivisionChiefofMaternalFetalMedicine,DepartmentofObstetricsand
Gynecology,CarolinasMedicalCenter

SajuJoy,MD,MSisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AmericanInstituteofUltrasoundinMedicine,SocietyforMaternalFetalMedicine,American
MedicalAssociation

Disclosure:Nothingtodisclose.

MatthewMFinneran,MDResidentPhysician,DepartmentofObstetricsandGynecology,CarolinasHealthcare
System

Disclosure:Nothingtodisclose.

Acknowledgements
PamelaLDyne,MDProfessorofClinicalMedicine/EmergencyMedicine,UniversityofCalifornia,LosAngeles,
DavidGeffenSchoolofMedicineAttendingPhysician,DepartmentofEmergencyMedicine,OliveViewUCLA
MedicalCenter

PamelaLDyne,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergencyMedicine,
AmericanCollegeofEmergencyPhysicians,andSocietyforAcademicEmergencyMedicine

Disclosure:Nothingtodisclose.

PatrickKo,MDClinicalAssistantProfessor,DepartmentofEmergencyMedicine,NewYorkUniversityMedical
SchoolAssistantProgramDirector,DepartmentofEmergencyMedicine,NorthShoreUniversityHospital

PatrickKo,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysiciansand
SocietyforAcademicEmergencyMedicine

Disclosure:Nothingtodisclose.

DeborahLyon,MDDirector,DivisionofGynecology,AssociateProfessor,DepartmentofObstetricsand
Gynecology,UniversityofFloridaHealthScienceCenteratJacksonville

DeborahLyon,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AssociationofAmericanMedicalColleges,AssociationofProfessorsofGynecologyand
Obstetrics,andFloridaMedicalAssociation

http://emedicine.medscape.com/article/262063differential 5/7
15/10/2016 PlacentaPreviaDifferentialDiagnoses
Disclosure:Nothingtodisclose.

JohnGPierceJr,MDAssociateProfessor,DepartmentsofObstetrics/GynecologyandInternalMedicine,
MedicalCollegeofVirginiaatVirginiaCommonwealthUniversity

JohnGPierceJr,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
Gynecologists,AssociationofProfessorsofGynecologyandObstetrics,ChristianMedical&DentalSociety,
MedicalSocietyofVirginia,andSocietyofLaparoendoscopicSurgeons

Disclosure:Nothingtodisclose.

JosephJSachter,MD,FACEPConsultingStaff,DepartmentofEmergencyMedicine,MuhlenbergRegional
MedicalCenter

JosephJSachter,MD,FACEPisamemberofthefollowingmedicalsocieties:AmericanAcademyof
EmergencyMedicine,AmericanCollegeofEmergencyPhysicians,AmericanCollegeofPhysicianExecutives,
AmericanMedicalAssociation,andSocietyforAcademicEmergencyMedicine

Disclosure:Nothingtodisclose.

RyanAStone,MDFellow,DepartmentofObstetricsandGynecology,MaternalFetalMedicineSection,Wake
ForestUniversityHealthSciences

RyanAStone,MDisamemberofthefollowingmedicalsocieties:AcademicPediatricAssociation,American
CollegeofObstetriciansandGynecologists,AmericanMedicalAssociation,andSocietyforMaternalFetal
Medicine

Disclosure:Nothingtodisclose.

FranciscoTalavera,PharmD,PhDAdjunctAssistantProfessor,UniversityofNebraskaMedicalCenterCollege
ofPharmacyEditorinChief,MedscapeDrugReference

Disclosure:MedscapeSalaryEmployment

LoreneTemming,MDResidentPhysician,DepartmentofObstetricsandGynecology,CarolinasMedicalCenter

LoreneTemming,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofObstetriciansand
GynecologistsandNorthCarolinaMedicalSociety

Disclosure:Nothingtodisclose.

YoungYoon,MDAssociateDirector,AssistantProfessor,DepartmentofEmergencyMedicine,MountSinai
MedicalCenter

YoungYoon,MDisamemberofthefollowingmedicalsocieties:SocietyforAcademicEmergencyMedicine

Disclosure:Nothingtodisclose.

MarkZwanger,MD,MBAAssistantProfessor,DepartmentofEmergencyMedicine,JeffersonMedicalCollege
ofThomasJeffersonUniversity

MarkZwanger,MD,MBAisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine,AmericanCollegeofEmergencyPhysicians,andAmericanMedicalAssociation

Disclosure:Nothingtodisclose.

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