Placenta previa (placenta previae) is an obstetric complication in which
the placenta is lying unusually low in your uterus, next to or covering your
cervix.
Symptoms
It can sometimes occur in the later part of the first trimester, but usually
during the second or third. It is a leading cause ofantepartum
hemorrhage (vaginal bleeding)
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
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. Previa 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. Previa
can be confirmed with an ultrasound.
Classification
Placenta previa is classified according to the placement of the placenta:
Type I or marginal: The placenta touches, but does not cover, the top
of the cervix.
Type II or partial: The placenta partially covers the top of the cervix
Type III or complete: The placenta completely covers the top of the
cervix
Who's most at risk for placenta previa?
Most women who develop placenta previa have no apparent risk factors. But
if any of the following apply to you, you're more likely to have this
complication:
• You had placenta previa in a previous pregnancy.
• You're pregnant with twins or higher-order multiples.
• You've had c-sections before. (The more c-sections you've had, the
higher the risk.)
• You've had some other uterine surgery (such as a D&C or fibroid
removal).
• You're a cigarette smoker.
• You use cocaine.
Also, the more babies you've had and the older you are, the higher your risk.
Treatment
If the placenta is near the cervix or is covering a portion of it, you may need
to reduce activities and stay on bed rest
If there is bleeding, however, you will most likely be admitted to a hospital
for careful monitoring.
If you have lost a lot of blood, blood transfusions may be given. You may
receive medicines to prevent premature labor and help the pregnancy
continue to at least 36 weeks. Beyond 36 weeks, delivery of the baby may
be the best treatment.
Women with placenta previa most likely need to deliver the baby by
cesarean section. This helps prevent death to the mother and baby. An
emergency c-section may be done if the placenta actually covers the cervix
and the bleeding is heavy or very life threatening.
Complications:
Risks to the mother include:
• Death
• Major bleeding (hemorrhage)
• Shock
There is also an increased risk for infection, blood clots, and necessary blood
transfusions. Prematurity causes most infant deaths in cases of placenta
previa. The baby may lose blood if the placenta separates from the wall of
the uterus during labor. The baby also can lose blood when the uterus is
opened during a C-section delivery.
Nursing Management
1. Ensure the physiologic well-being of the client and fetus
a. Take and record vital signs, assess bleeding, and maintain a perineal
pad count. Weigh perineal pads before and after use to estimate blood
loss.
b. Observe for shock, which is characterized by a rapid pulse, pallor, cold
moist skin and a drop in blood pressure
c. Monitor the FHR
d. Enforce strict bed rest to minimize risk to the fetus
e. Observe for additional bleeding episodes.
2. Provide client and family teaching
a. Explain the condition and management options. To ensure an
adequate blood supply to the mother and fetus, place the woman at
bed rest in a side-lying position. Anticipate the order for a sonogram to
localize the placenta. If the condition of mother or fetus deteriorates, a
cesarean birth will be required.
b. Prepare the client for ambulation and discharge ( may be within 48
hours of last bleeding episode)
c. Discuss the need to have transportation to the hospital available at all
times.
d. Instruct the client to return to the hospital if bleeding recurs and to
avoid intercourse until after the birth.
e. Instruct the client on proper handwashing and toileting to prevent
infection.
3. Address emotional and psychosocial needs
a. Offer emotional support to facilitate the grieving process, if needed
b. After birth of the newborn, provide frequent visits with the newborn so
that the mother can be certain of the infant’s condition
