PLACENTA PREVIA

placenta previa

A condition of pregnancy in which placenta is implanted abnormally in the lower part of the uterus. It is the most common cause of painless bleeding in the third trimester of pregnancy.

Incidence: the most common cause of bleeding in the third trimester occurs 1:150 to 1:200

RISK/PREDISPOSING FACTORS

1. Multiparity: the single most important factor

2. Decreased vascularity in the upper uterine

segment as in scarring and tumor

3. Increased age: above 35 years

4. Multiple pregnancy

5. Scarring of the upper lining tissues of the

uterus (cause by prior CS deliveries, prior

instrumentation, or any type of surgery

involving uterus)

Types/Degree

• TYPE I: Low lying

• TYPE II: Marginal

• TYPE III: Incomplete/Partial

• TYPE IV: Complete or Total

TYPE I: Low lying

Placenta at the lower third of the uterus;

does not cover the internal os.

TYPE II: Marginal

Placenta lies over the margins of internal os.

TYPE III: Incomplete/Partial

Placenta partly covers the internal os.

TYPE IV: Complete or Total

Placenta totally covers the internal os.

SIGNS AND SYMPTOMS

● Uterus feels relaxed and soft; intermittent

hardening if in labor

● The head is floating in contrast to the peri

of gestation

● Fetal heart sound is usually present

● Vaginal Inspection: placenta is felt on the

lower segment

● Painless vaginal bleeding (fresh, bright red,

external) in the third trimester or seventh

month

● Intermittent pain if it happens in labor

secondary to uterine contractions

PREVENTION

● Adequate antenatal care

● Significance of warning hemorrha

Put the patient on bed

● Abdominal examination

● Vaginal examination must not be done

- Bleeding from placenta previa can be

reduced in many cases by bed rest,

limitation of activity, and/or avoiding sexual

intercourse.

COMPLICATIONS

a. Hemorrhage

b. Prematurity

c. Obstruction of the birth canal

DIAGNOSTIC TESTS

1. Ultrasound

2. Vaginal examination

3. Abdominal presentation

Pharmacologic Therapy

● To ensure an adequate blood supply to a

woman and fetus, place the women

immediately on bed rest in a side lying

position.

● A large bore IV cannula is cited and infusion

of normal saline.

● Gentle abdominal palpation.

Surgical Management

● If the patient is not in labor, look to the

amount of bleeding

- If the bleeding is severe, continue

antishock measures and do an

immediate cesarean section.

- If the bleeding is slight, look at the

gestation age (If completed 37

weeks or 36 weeks by some

authors or more, pregnancy is

terminated by induction of labour or

cesarean section. At this time, the

fetus is mature and the mother will

be at risk of severe hemorrhage as

term approaches).

- If the placental edge is within 2 cm

from the internal os, no internal

examination is performed and

cesarean section is considered as

the best choice.

NURSING IMPLEMENTATION

1. Maintain bedrest - left lateral recumbent with a head pillow.

2. Do not perform an IE or vaginal examination

3. Careful assessment: VS, bleeding,

onset/progress of labor, FHT.

4. Prepare the patient for diagnostic

ultrasonography.

5. Institute shock measures as necessary.

Initially, bleeding in previa is rarely

life-threatening but may become profuse

with internal examination.

6. Provide psychosocial and physical comfort.

7. Prepare for conservative management,

double set up, or classical CS.

8. Observe bleeding after delivery: The lower

uterine segment, the site of placental

detachment, is not contractile as the upper

fundal portion.