A 38-year-old woman, gravida 3, para 2, at 32 weeks' gestation comes to the physician because of bleeding from the vagina. She states that this morning she passed 2 quaer-sized clots of blood from her vagina. Otherwise, she states that she is feeling well. The baby has been moving normally and she has had no contractions or gush of fluid from the vagina. Her obstetrical history is significant for 2 low-transverse cesarean deliveries for non-reassuring fetal hea rate tracings. An ultrasound is performed that demonstrates a complete placenta pre. For which of the following conditions is this patient at highest risk?
Placenta pre is defined as a placenta located over the cervical os. There are 3 major types. Complete pre describes a placenta that completely covers the cervical os. Paial pre is a placenta that covers some of the cervical os, with the remainder of the os uncovered by the placenta. Marginal pre describes a placenta that is located at the edge of the cervical os. Three major risk factors for placenta pre are maternal age, minority race, and previous cesarean delivery. Placenta accreta describes the condition in which there is abnormal attachment of the placenta to the uterine wall. In this condition, the decidua basalis is absent and the placenta is attached to the myometrium(accreta) or invades into the myometrium (increta) or perforates through the myometrium (percreta). Many patients with a pre and accreta will require a hysterectomy at the time of delivery. This patient, with a history of 2 prior cesarean deliveries and a placenta pre is at highest risk for placenta accreta. This patient would not be considered to be at highest risk of dystocia (Choice A) because, with a placenta pre, she would not be allowed to labor and, therefore, would not be at risk of dystocia
Dystocia
Intrauterine fetal demise (IUFD)
Placenta accreta
Preeclampsia