Placenta Previa

Def: Placenta is partially or fully covering the cervical opening

REMEMBER: The 3 P’s = Placenta Previa Painless

KEY: Diagnose in the 2nd trimester at 20 weeks and recheck at 30 weeks, because it can correct itself

S/Sx: “I have bright red bleeding but no pain” or “I started bleeding after sex.”

Interventions: no vaginal exams, no manipulation, bed rest, may need c-section if bleeding does not stop

🩺 Vital Signs to Monitor

Mother

• Blood Pressure (BP)

  • May be normal initially

  • Can drop (hypotension) if significant bleeding occurs

• Heart Rate (HR)

  • Often increased (tachycardia) due to blood loss

• Respiratory Rate (RR)

  • May increase with shock or anxiety

• Oxygen Saturation (SpO₂)

  • Usually normal, but monitor for decreases if severe hemorrhage

• Temperature

  • Typically normal (fever is NOT expected unless infection)

Fetus

• Fetal Heart Rate (FHR)

  • Usually normal early on

  • May show tachycardia (early distress)

  • Later signs: bradycardia or late decelerations if severe hypoxia

⚠ What You Expect to See

Classic Findings

• Painless, bright red vaginal bleeding

• Bleeding often occurs suddenly

• Soft, non-tender uterus (key difference from Placental Abruption)

• No abdominal pain

If Bleeding Becomes Severe

• Signs of hypovolemic shock:

  • ↓ BP

  • ↑ HR

  • Cool, clammy skin

  • Altered mental status

• Decreased urine output (<30 mL/hr)

🚨 Important Nursing/Clinical Notes

• DO NOT perform vaginal exams (can trigger severe hemorrhage)

• Monitor:

  • Pad counts (blood loss)

  • Hemoglobin/hematocrit

• Prepare for:

  • IV fluids or blood transfusion

  • Possible cesarean delivery