Multiparas may also experience precipitate labor, with increased risk of hemorrhage and of amniotic fluid embolism. Placenta previa is more common in the grand multipara. Having twins also runs in families. Hysteroscopy or hysterosalpingography may be indicated to diagnose these conditions and may be useful to confirm cervical incompetency, which may also be documented by serial ultrasonography of the cervix during the 1st trimester. Hysteroscopy or hysterosalpingography may be indicated to diagnose fibroids.
Differential diagnosis includes twisted or ruptured adnexa and appendicitis.
Treatment of carneous degeneration consists of fluids, rest, and pain relief. If a woman has had a newborn with significant hemolytic disease, the blood type of both parents should be determined, and the woman should be screened for blood group antibodies as early as possible. There are clear, effective protocols for the management of pregnancy in nonsensitized women who have Rh-negative blood and in women with atypical antibodies. Appropriate antibiotic therapy may prevent premature rupture of membranes and may arrest preterm labor. For all pregnant women, a midstream urine specimen should be collected for culture early in pregnancy.