Match each clinical presentation or ultrasound/pathologic finding of abnormal placentation and bleeding with the corresponding obstetric diagnosis.
- Ultrasound reveals an anterior placenta with an absent retroplacental clear space, and chorionic villi attaching directly to the superficial myometrium without penetration.Placenta accreta
- Pathologic examination of a postpartum hysterectomy specimen demonstrates chorionic villi invading deep into the muscularis layer of the uterus.Placenta increta
- Intraoperative visualization during a repeat cesarean delivery shows placental tissue penetrating completely through the uterine serosa and extending into the posterior bladder wall.Placenta percreta
- Amniotomy is immediately followed by painless, bright red vaginal bleeding and sudden, profound fetal bradycardia displaying a sinusoidal heart rate pattern.Vasa previa
- A patient presents with sudden-onset severe, tearing abdominal pain, dark vaginal bleeding, and a rigid, hypertonic uterus on physical examination.Placental abruption
Answer
Placenta accreta matches with superficial myometrial attachment; Placenta increta matches with deep myometrial invasion; Placenta percreta matches with serosal/bladder penetration; Vasa previa matches with painless bleeding after amniotomy causing fetal bradycardia; Placental abruption matches with painful bleeding and a rigid uterus.
The matching correctly identifies the spectrum of placenta accreta (accreta, increta, percreta) based on the progressive depth of villous invasion from the superficial myometrium to adjacent organs. It also correctly distinguishes the painless, fetal-origin bleeding of vasa previa from the painful, maternal-origin bleeding of placental abruption.
Step-by-Step Solution
Key Concept
Differentiating etiologies of third-trimester bleeding and morbidly adherent placentation based on the depth of chorionic villi invasion and distinct clinical presentations.