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The placenta is implanted in the lower uterine segment near or over the internal
cervical os. The degree to which the internal cervical os is covered by the placenta
has been used to classify four types of placenta previa; total, partial, marginal and
low–lying. In total previa the internal os is entirely covered by the placenta. Partial
placenta previa implies incomplete coverage of the internal os. Marginal placenta
previa indicates that only an edge of the placenta extends to the margin of the
internal os. And the last is the low – lying placenta has been used when the placenta
is implanted in the lower uterine segment but not reach the os. The more descriptive
classification that includes placenta previa is in the third trimester.
The incidence of placenta previa is approximately 0.5% of births. The most important
risk factors are previous placenta previa, previous cesarean birth, and suction
curettage for miscarriage or induced abortion, possible related to endometrial
scarring. The risk also increases with multiple gestations because of the larger
placental area, closely spaced pregnancies, advanced maternal age older than 34
years, African or Asian ethnicity, male fetal sex, smoking, cocaine use, multiparity,
and tobacco use.
1. Total Previa- the placenta completely covers the internal cervical os.
2. Partial Previa- the placenta covers a part of the internal cervical os.
3. Marginal Previa- the edge of the placenta lies at the margin of the internal
cervical os and may be exposed during dilatation.
4. Low-lying placenta- the placenta is implanted in the lower uterine segment
but does not reach to the internal os of the cervix.
Predisposing Factors:
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
1. 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.
2. 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.
3. The placental site is usually located on either the anterior or the posterior
uterine wall.
4. The amniotic membranes are adhered to the inner wall of the uterus except
where the placenta is located
Pathophysiology
No specific cause of placenta previa has yet been found but it is hypothesized to be
related to abnormal vascularisation of the endometrium caused by scarring or
atrophy from previous trauma, surgery, or infection.
In the last trimester of pregnancy the isthmus of the uterus unfolds and forms the
lower segment. In a normal pregnancy the placenta does not overlie it, so there is no
bleeding. If the placenta does overlie the lower segment, it may shear off and a small
section may bleed.
Women with placenta previa often present with painless, bright red vaginal bleeding.
This bleeding often starts mildly and may increase as the area of placental separation
increases. Praevia should be suspected if there is bleeding after 24 weeks of
gestation. Abdominal examination usually finds the uterus non-tender and relaxed.
Leopold’s Maneuvers may find the fetus in an oblique or breech position or lying
transverse as a result of the abnormal position of the placenta. Praevia can be
confirmed with an ultrasound.[3] In parts of the world where ultrasound is
unavailable, it is not uncommon to confirm the diagnosis with an examination in the
surgical theatre.
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
Fetoscope
Medical Management:
Nursing Interventions:
Discharge Plan:
Medication
Exercise
• Needs to adequate her time with her child to be certain he or she is all right,
and nurse can states hearing fetal heart beat helps to reassure her about
baby’s health.
• Attach contraction and fetal heart rate monitoring for continuous evaluation of
contractions of fetal response.
Treatment
• Used of drugs
• Catheterization
Health Teaching
Ongoing Assessment
Diet
• She might to begin to neglect her diet or her supplementary vitamins because
“It doesn’t matter anymore”.
Spiritual
• Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation
• Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental
Implantation
• Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation
• Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood
Loss
• Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to
Potential for Hemorrhage
• Altered Diversional Activity r/t Inability to Engage in Usual Activities
Secondary to Enforced Bed Rest and Inactivity During Pregnancy