Placenta accreta spectrum Quiz: Ace Your Exams

A 41-year-old primigravid woman presents at 16 weeks’ gestation with hematuria. The patient has no dysuria or increased urinary urgency. Medical history is notable for infertility, and the patient conceived following a procedure involving multiple myomectomies and in vitro fertilization. The patient is otherwise healthy and only takes a prenatal vitamin. Temperature is 36.7°C (98.1°F), pulse is 74/min, respirations are 12/min, and blood pressure is 112/70 mmHg. On examination, the patient appears well. There is no uterine or suprapubic tenderness. Speculum exam shows no vaginal bleeding and a closed cervix. An ultrasound demonstrates a single viable fetus and an anterior placenta covering the internal os. There are multiple placental lacunae, loss of the hypoechoic clear zone between the placenta and uterine wall, and retroplacental myometrial thinning. An area of hypervascularity over the posterior bladder wall is noted. Urinalysis results are displayed below. Which of the following strategies would be most appropriate for reducing the risk of postpartum hemorrhage (PPH) in this patient?

Laboratory Value	Result	Reference Range
Urinalysis
Color	Clear	Clear to light yellow
Specific gravity	1.013	1.003-1.035
Glucose	Negative	Negative
Blood	3+	Negative
Leukocyte esterase	Negative	Negative
Nitrites	Negative	Negative