Placenta Previa – Nomenclature, Diagnosis and Clinical Management
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Identify patient risk factors which may lead to placenta previa 2. Define placenta previa
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
The incidence of placenta previa is 1/200 pregnancies. Most cases of placenta previa will be identified prenatally by prenatal ultrasound. The following is recommended regarding mode and timing of delivery
Placenta previa: Cesarean delivery only
Placenta edge is ≥2.0 cm from the internal cervical os
Trial of labor is appropriate
Placental edge is between 1.0 cm and 2.0 cm from the internal cervical os
Management is uncertain
Timing of delivery in stable cases
ACOG/SMFM: 36w0d to 37w6d
Hospitalize when there are contractions or vaginal bleeding
Consider corticosteroids to enhance pulmonary maturity when there is vaginal bleeding <34 weeks gestation
The benefits of tocolysis, bed rest, pelvic rest and reduced activity is uncertain
The nomenclature has been modified and the terms partial and marginal have been eliminated. All placentas which overlie or abut the internal cervical os (to any degree) should be referred to as placenta previa. A placenta which is near to but not overlying the os is termed a low-lying placenta.
Role of ultrasound
Transvaginal ultrasound is the recommended approach
Transvaginal ultrasound is more accurate than transabdominal approach
If placenta previa is suspected on transabdominal ultrasound, a transvaginal ultrasound should be performed
Placenta previa identified during second trimester ultrasound
Placenta previa may be seen in 1 to 4% of second trimester ultrasound exams
10 to 20% of previas diagnosed at 20 weeks gestation will remain a previa in the late 3rd trimester
Repeat ultrasound at 32 weeks gestation
The incidence of placenta previa is increased by
Number of previous cesarean sections
Number of previous spontaneous deliveries
the number of elective terminations
prior uterine surgery
prior placenta previa
Fetal complications are primarily those associated with prematurity
There is an increased risk of postpartum hemorrhage in patient with placenta previa
General anesthesia may increase blood loss without improving safety
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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