PLACENTA PREVIA

Definition:
Placenta previa is an obstetric complication that occurs in the second and third trimesters
of pregnancy. It may cause serious morbidity and mortality to both the fetus and the mother. It is
one of the leading causes of vaginal bleeding in the second and third trimesters.
 Is an abnormal low implantation of the placenta in proximity to the internal cervical os.
 Placenta previa is a condition in which the placenta attaches to the uterine wall in the
lower portion of the uterus and covers all or part of the cervix.

Classification of Placenta Previa:

 Total Previa- the

placenta completely covers the internal cervical os.
 Partial Previa- the placenta covers a part of the internal cervical os.
 Marginal Previa- the edge of the placenta lies at the margin of the internal cervical os and
may be exposed during dilatation.
 Low-lying placenta- the placenta is implanted in the lower uterine segment but does not
reach to the internal os of the cervix.

Anatomy and Physiology

Normal Placenta during Childbirth
Process of placental growth and uterine wall changes during pregnancy
1. The placenta grows with the placental site during pregnancy.

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 2. During pregnancy and early labor the area of the placental site probably changes little,
even during uterine contractions.
3. The semirigid, noncontractile placenta cannot alter its surface area.

Anatomy of the uterine/placental compartment at the time of birth

a) The cotyledons of the maternal surface of the placenta extend into the decidua basalis,
which forms a natural cleavage plane between the placenta and the uterine wall.
b) There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the
branches of the uterine arteries that run through the wall of the uterus to the placental
area.
c) The placental site is usually located on either the anterior or the posterior uterine wall.
d) The amniotic membranes are adhered to the inner wall of the uterus except where the
placenta is located

Risk factors
 Advanced maternal age
 Multiparity
 Previous uterine surgery
 Large placenta (multiple gestation, erythroblastosis)
 Maternal smoking
True placenta previa at term is very serious. Complications for the baby include:
 Problems for the baby, secondary to acute blood loss
 Intrauterine growth retardation due to poor placental perfusion
 Increased incidence of congenital anomalies

Signs and Symptoms:

Signs and symptoms of placenta previa vary, but the most common symptom is painless bleeding
during the third trimester. Other reasons to suspect placenta previa would be:
 Premature contraction
 Baby is breech, or in transverse position

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  Uterus measures larger than it should according to gestational age.

Clinical Manifestations:
 Painless vaginal bleeding > occurs after 20 weeks of gestation, bright red in color
associated with the stretching and thinning of the lower uterine segment that occurs in
third trimester.
 Adequately contract and stop blood flow from open vessels.
 Stop blood flow from open vessels
 Decreasing urinary output

Diagnostic Evaluation:
Placenta previa is diagnosed using transabdominal ultrasound.
- transabdominal scans with fewer false positive results
 Transvaginal ultrasound
 If a woman is bleeding she is usually placed in the labor and birth unit or for cesarean
birth because profound hemorrhage can occur during the examination. This type of
vaginal examination knows as the double- setup procedure
 Ultrasonographic scan
 If ultrasonographic scanning reveals a normally implanted placenta, an examination may
be performed to rule out local causes of bleeding and a coagulation profile is obtained to
rule out other causes of bleeding management of placenta previa depends of the
gestational age and condition of the fetus and the amount and cesarean birth.
 Complete blood count (CBC)- To monitor mother’s blood volume
 Fetoscope- To monitor fetal heart rate and conditions

Management:
 May be given drugs that can prevent premature labor or birth example is progesterone.
 Ultrasound exams to determine migration of an early diagnosed previa or classification of
the previa as total, partial, marginal, or low-lying.

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  With a small first bleed, client may send home on bed rest if she can return to hospital
quickly.
 If bleeding is more profuse client is hospitalized on bed rest with BRP, IV access; labs:
Hgb and Hct, urinalysis, blood group and type and cross match for 2 units of blood hold,
possible transfusions; goal is to maintain the pregnancy fetal maturity.
 No vaginal exams are performed except under special conditions requiring a double set-
up for immediate cesarean birth should hemorrhage result.
 Low lying or marginal previas may allow delivering vaginally if the fetal head acts as
tamponade to prevent hemorrhage.
 Cesarean birth, often with vertical uterine incision, is used for total placenta previa.
 Steroid shots may be given to help mature the baby's lungs.

Nursing Interventions:
 If continuation of the pregnancy is deemed safe for patient and fetus administer

magnesium sulfate as ordered for premature labor

 Obtain blood samples for complete blood count and blood type and cross matching

 Institute complete bed rest

 If the patient and placenta previa is experiencing active bleeding, continuously monitor

her blood pressure, pulse rate, respiration, central venous pressure, intake and output, and

amount of vaginal bleeding as well as the fetal heart rate and rhythm

 Assist with application of intermittent or continuous electronic fetal monitoring as

indicated by maternal and fetal status.

 Have oxygen readily available for use should fetal distress occur, as indicated by

bradycardia, tachycardia, late or available decelerations, pathologic sinusoidal pattern,

unstable baseline, or loss of variability.

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 If the patient is Rh-negative and not sensitized, administer Rh (D) immune globulin

(RhoGAM) after every bleeding episode.

 Administer prescribed IV fluids and blood products.

 Provide information about labor progress and the condition of the fetus.

 Prepare the patient and her family for a possible caesarian delivery and the birth of a

preterm neonate, and provide thorough instructions for postpartum care.

 If the fetus less than 36 weeks gestation expect to administer an initial dose of

betamethasone: explain that additional doses may be given again in 24 hours and possibly

for the next 2 weeks to help mature the neonates lungs.

 Explain that the fetus survival depends on gestational age and amount of maternal blood

loss. Request consultation with a neontologist or pediatrician to discuss a treatment plan

with the patient and her family.

 Assure the patient that frequent monitoring and prompt management greatly reduce the

risk of neonatal death.

 Encourage the patient and her family to verbalize their feelings helps them to develop

effective coping strategies, and refer them for counseling, if necessary.

 Anticipate the need for a referral for home care if the patient bleeding ceases and she’s to

return home in bed rest.

 During the postpartum period, monitor the patient for signs of early and late postpartum

hemorrhage and shock.

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