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Emergency Medical Minute


Dec 21, 2021

Contributor: Peter Bakes, MD

Educational Pearls:

  • High concern causes of third trimester vaginal bleeding include placenta previa, placental abruption, or vasa previa
  • In placenta previa, the placenta implants over the cervix and this condition
    • Often noted during routine prenatal care on transabdominal ultrasound
  • Patients present with painful vaginal bleeding, usually in the absence of trauma
  • Avoid pelvic exam, transvaginal ultrasound, or digital vaginal exam in placenta previa
  • Risk factors for placenta previa include multiple gestations, previous medical abortions, advanced maternal age, and previous placenta previa
  • Management usually includes admission to the hospital
    • >37 weeks: admission for c-section
    • 34-37 weeks: judgment call based on maternal/fetal stability
    • <34 weeks: steroids for fetal lung maturation and delay delivery 


Anderson-Bagga FM, Sze A. Placenta Previa. [Updated 2021 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:

Young JS, White LM. Vaginal Bleeding in Late Pregnancy. Emerg Med Clin North Am. 2019;37(2):251-264. doi:10.1016/j.emc.2019.01.006

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD

*Image from BruceBlaus via Wikimedia Commons licensed under Creative Commons license

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