Placenta

Previa
an obstetriccomplication in which the placenta is
attached to the uterine wall close to or covering
the cervix. It can sometimes occur in the later part
of the first trimester, but usually during the second
or third. It is a leading cause of antepartum
hemmorhage (vaginal bleeding). It affects
 of Placenta
• Total Previa - the placenta completely covers the

Previa
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.
Predisposing
Factors:
• Multiparity (80% of affected clients are
multiparous)
• Advanced maternal age (older than 35 years old in
33% of cases
• Multiple gestation
• Previous Cesarean birth
• Uterine Incisions
• Prior placenta previa ( incidence is 12 times greater
in women with previous placenta previa)
 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
Manifestatio
ns:
• 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
 Pathophys
iology
• No specific cause 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. In parts of the world where ultrasound is unavailable.
 Diagnostic Evaluation:
• Transvaginal ultrasound
• Ultrasonographic scan
• Complete blood count (CBC)
• Fetoscope
 Medical Management:
• Maternal stabilization and fetal monitoring
• Control of blood loss, blood replacement
• Delivery of viable neonate
• With fetus of less than 36 weeks gestation, careful
observation to determine safety of continuing
pregnancy or need for preterm delivery
• Hospitalization with complete bed rest until 36 weeks
gestation with complete placenta previa
• Possible vaginal delivery with minimal bleeding or
rapidly progressing labor