Causes

Unknown
Possible link to genetics
(See Risk Factors)

Risk Factors
Previous Cesarean birth
Advanced maternal age
( >35-40 years of age)
Multiparity
History of suction curettage
Smoking
History of placenta previa
Multiple gestation
Hx of induced abortion
Hx of cesarean birth and
curettage (miscarriage)

Placenta Previa
When the placenta implants on the
lower uterine segment and either
completely or partially covers the
cervix. Bleeding can occur when the
cervix dilates or when the lower
uterine wall effaces. The stretching
and thinning of the lower uterine
wall is what causes the bleeding.
Initially the amount is small and
stops but it can occur again at any
time.

References:
Lowdermilk, D. L., Perry, S. E., & Cashion, K. (2014). Maternity
nursing (8th ed.). Maryland Heights, MO: Mosby Elsevier.

Signs/Sx
Painless bright red vaginal
bleeding (2nd-3rd semester)
Mom can lose up 40% of
her blood volume before
showing signs of shock
Decreased urine output
Soft, relaxed, non-tender
uterus, normal tone
Fundal height greater than
expected for gestational age

Diagnostic Tests
Transvaginal ultrasound
(Complete:internal cervical os
completely covered, Partial:
edge of placenta is 2.5cm or less
close to the internal cervical os)
Painless vaginal bleeding after
20 weeks of gestation
Transabdominal ultrasound
Transvaginal Scan
Coagulation profile
Speculum exam

Medications and Treatments

Managed as expectantly or
actively depending on gestational
age, amt of bleeding, and fetal
condition
Expectant: Observation/bedrest:
<36weeks, reassuring FHR, mild
bleeding <250ml and stops, not in
labor
CBC, large bore IV, antenatal
corticosteroids
Get OOB 15-30 mins at a
time/day
No vaginal, rectal examinations,
pelvic rest, NST, BPP, monitor for
bleeding and s/s of preterm labor
Possible emergency c-section
Monitor vitals
Possible home bedrest

Complications

Prognosis
Placenta previa is very serious and many
complications can occur that can endanger mother
and babys life, such as preterm birth, postpartum
hemorrhage, anemia, trauma from surgery and
adverse effects from anesthesia and blood
transfusion. History of placenta previa can predispose
for it to occur again in future pregnancies.

Fetal Malpresentation (breech,

transverse, oblique lie)
Premature rupture of
membranes
Preterm labor and birth
Trauma from surgery
Adverse effects from Anesthesia
Blood transfusion adverse
reactions
Postpartum hemorrhage
Over infusion of fluids
Thrombophlebitis
Infection
Anemia
Fetal death