Previa Protocol

• Complete placenta previa

o Placental edge is at or over the internal os of the cervix.

• Low lying placenta previa

o Placental edge is <2 cm away from the internal os of the cervix.

• Imaging

o Transvaginal ultrasound is essential for diagnosis of a complete or low-lying placenta previa.

 Obtain transvaginal cervical measurement.

 Measure the distance from placenta to internal os of cervix.

o Any second trimester previa should have a transvaginal side-to-side sweep with color of the internal os to rule out a vasa previa.

• Follow up:

o If a complete of low-lying previa is noted during anatomy scan scheduled patient to return for a screening ultrasound in

 4 weeks if anatomic survey is NOT complete for a Level 2 follow up and transvaginal ultrasound to evaluate placenta location.

 If all anatomy is obtained and anatomic survey is complete, schedule patient back at 28 weeks for a level 2 follow up, BPP and transvaginal ultrasound to evaluate placenta location.

 If at 28 weeks placenta is still complete or low lying, the patient should be scheduled to return in 4weeks for a level 3, transvaginal ultrasound and MFMC.

o Once the placenta is Resolved: A side-to-side sweep with color of the internal os needs to be obtained to rule out a vasa previa.

• Documenting

o Document on impression

 Placenta evaluated by transvaginal ultrasound and the distance placenta edge is from internal os of cervix.

 If there is any placental vascularity noted measure from the edge of the vascularity to the internal os.

 Once placenta is resolved document

 No evidence of vasa previa on the report.

 Document distance from placental edge to internal os of cervix.

• Any patient with a previa that reports vaginal bleeding,

o Call their OB provider for recommendations.

• If patient with a previa that is not bleeding:

o No recommendations will be given for pelvic rest by PANM sonographers.