Season 2 Case 11

History: Vaginal Bleeding

Season 2 Case 11

Case 11

History: vaginal bleeding

Answer:

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Oh wait, this is a 14 weeker, so it’s a second trimester and we don’t read those. Just leave it for the perinatologists, right?

Well we didn’t get a lot of answers on the quiz this week, but I’m not sure how many people actually played along. I got a few “placenta previa”. I agree that is it low lying, but remember that the placenta migrates up as the uterus enlarges so you really need to wait till about 20 weeks gestation to properly call a placenta previa (ref: http://radiopaedia.org/articles/placenta-previa - I think knowing the grading system / different types would be wise).

But what does the edge of the placenta look like? Is it flat against the wall? No, it is raised up. So this could be called a marginal placental abruption , which just happens to be in the region of the cervix (again, makes sense with the bleeding right?). Some authors suggest to reserve abruption for >20wks gestation (much like previa) but I still find it wise to look for it and describe it as seperation none-the-less, and likely accounting for the bleeding (especially in this case).

Nice reference for placental imaging/ abnormalities here: http://radiographics.rsna.org/content/29/5/1371.full

Arrows pointing to the separation of the edge of the placenta from the wall of the uterus

notice the location of the cervix