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?
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?
💡 Explanation
**Core Concept**
The patient in this scenario is at risk for a condition that involves a life-threatening complication of placenta previa, where the placenta covers the cervix and can cause severe bleeding during pregnancy or delivery. This condition requires prompt recognition and management to prevent maternal and fetal morbidity and mortality.
**Why the Correct Answer is Right**
The patient's history of two previous low-transverse cesarean deliveries and current diagnosis of complete placenta previa puts her at high risk for placenta accreta spectrum (PAS) disorders. Placenta accreta occurs when the placenta invades the uterine wall, leading to abnormal placental attachment. This can cause severe bleeding during pregnancy or delivery, which can be life-threatening for both the mother and the fetus. The risk of PAS disorders is increased in patients with previous uterine surgery, such as cesarean deliveries.
**Why Each Wrong Option is Incorrect**
**Option A:** Placenta previa itself is a risk factor for bleeding, but it is not the condition being asked about. The question is asking for a condition that is a complication of placenta previa.
**Option B:** Placenta accreta is the correct answer, but this option is incomplete. The correct answer is "placenta accreta spectrum (PAS) disorders".
**Option C:** Placental abruption is a condition where the placenta separates from the uterus, but it is not directly related to placenta previa or the patient's history of cesarean deliveries.
**Clinical Pearl / High-Yield Fact**
Patients with a history of previous uterine surgery, such as cesarean deliveries, are at increased risk for placenta accreta spectrum (PAS) disorders, which can cause severe bleeding during pregnancy or delivery.
**Correct Answer: D. Placenta accreta spectrum (PAS) disorders.**
✓ Correct Answer: C. Placenta accreta
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