Placenta previa occurs when the placenta partially or completely overlies the internal cervical os. Because of the rich vasculature of the placenta, disruption of the placenta by minor manipulation, even a bimanual examination or early cervical dilatation, may induce catastrophic maternal hemorrhage. The presence of placenta previa should be suspected in any third-trimester patient presenting with painless vaginal bleeding, particularly bright red blood per vagina. The primary risk factor for placenta previa is a history of prior cesarean section(s). If previa is suspected, an emergent ultrasound prior to speculum or bimanual examination is required. 4 (Also see Chap 108, "Complications of Gynecologic Procedures.") If previa is present on ultrasound and the patient is actively laboring, no further examination should be performed and arrangements should be made for immediate transport to labor and delivery for cesarean section. Patients who are not in labor and bleeding only minimally can sometimes be managed conservatively by observation.
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