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Painless vaginal bleeding is characteristic of placenta previa
Uterine contractions, pain, and tenderness are more often associated with abruptio placentae
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Placental causes (placenta previa, placental abruption, vasa previa) must be differentiated from nonplacental causes (infection, disorders of the lower genital tract, systemic disease)
Complete blood count with platelets and a prothrombin time (INR) should be obtained and repeated serially if the bleeding continues
Coagulation studies may be indicated
Ultrasonography can determine placental location
Digital pelvic examinations are done only after placenta previa has been excluded
Amniocentesis may be performed to assess for fetal lung maturity in patients < 36 weeks' gestational age
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Approach should be conservative and expectant unless fetal distress or risk of severe maternal hemorrhage occurs
Patients should initially be observed closely with fetal monitoring to assess for fetal distress
Hospitalization and bed rest are continued if the patient is < 36 weeks' gestation
Home management may be considered in selected patients
Corticosteroid therapy is indicated if fetal lung immaturity is present
If hemorrhage is significant or if there is evidence of acute hypovolemia, the need for transfusion should be anticipated and an appropriate volume of red cells prepared with cross-matching
Administration of anti-D immune globulin may be required for women who are Rh negative
For placenta previa,
For morbidly adherent placenta,
Evidence-based recommendations regarding delivery timing are lacking
However, the goal is to have a planned, late-preterm cesarean delivery managed by a multidisciplinary team
Delivery at 34–36 weeks in a stable patient seems a reasonable approach
For placental abruption, immediate cesarean delivery is indicated because of the high risk of fetal death