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Placenta Praevia

Placenta praevia involves implantation of the placenta over the internal cervical os. A leading cause of third trimester haemorrhage, placenta praevia presents classically as painless bleeding. Any pregnant patient beyond the first trimester who presents with vaginal bleeding requires a speculum examination followed by diagnostic ultrasound, unless previous documentation confirms no placenta praevia. Because of the risk of provoking life-threatening haemorrhage, a digital examination is absolutely contraindicated until placenta praevia is excluded. If bleeding persists, a double setup exam in preparation for immediate surgery is indicated. If more that one episode of bleeding occurs during gestation (at viability or > 24 wk), the clinician should consider hospitalization until delivery given the increased potential for placental abruption and fetal demise. Cesarean delivery is the safest mode of delivery.


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