Placenta — Structure, Abnormalities and Pathology

A 32-year-old primigravida at 28 weeks of gestation presents to the antenatal clinic with painless vaginal bleeding. Obstetric examination reveals a soft, non-tender uterus. Speculum examination shows blood coming from the cervix. Ultrasound shows the placenta covering the internal cervical os completely, with no gap between the placental edge and the os. The fetal heart rate is 145 bpm and amniotic fluid volume is normal. What is the most likely diagnosis and the recommended management at this gestation?

A 38-year-old multiparous woman (G3P2) with a history of two prior cesarean deliveries presents at 32 weeks of gestation with vaginal bleeding. Transvaginal ultrasound shows the placenta in the lower uterine segment with invasion into the myometrium; there is loss of the normal retroplacental sonolucent space, and multiple bridging vessels are seen crossing the placental-myometrial interface. The patient is hemodynamically stable. What is the most likely diagnosis, and what is the single most important step in management?

Which layer of the placenta is derived from fetal tissue and contains fetal blood vessels?

A 32-year-old primigravida at 28 weeks of gestation presents to the antenatal clinic with painless vaginal bleeding. Obstetric examination reveals a soft, non-tender uterus. Speculum examination shows blood pooling in the vagina. Ultrasound reveals the placenta covering the internal cervical os completely, with no gap between the placental edge and the os. The fetal heart rate is 145 bpm and amniotic fluid volume is normal. What is the most likely diagnosis?

A 28-year-old multigravida (G3P2) at 34 weeks of gestation is admitted with acute-onset severe abdominal pain and vaginal bleeding. On examination, the uterus is tender and rigid, with a board-like consistency. Fetal heart rate is 90 bpm with recurrent decelerations. Ultrasound shows a hypoechoic collection between the placenta and uterine wall, with placental thickness of 6 cm. Maternal hemoglobin has dropped from 11.5 g/dL to 9.2 g/dL in 4 hours. What is the most likely diagnosis?