Placenta Previa

Now that the pregnant woman is in the final trimester of her pregnancy, the risks that could harm the fetus inside also get more perilous. Months away from birth, a woman should not be complacent of her condition at all times. Her guard must always be up, and further education is necessary to enforce her awareness of how precious and fragile the life inside of her is.

Definition

  • Placenta previa is a condition wherein the placenta of a pregnant woman is implanted abnormally in the uterus. It accounts for the most incidents of bleeding in the third trimester of pregnancy.

Pathophysiology

  • The placenta implants on the lower part of the uterus.
  • The lower uterine segment separates from the upper segment as the cervix starts to dilate.
  • The placenta is unable to stretch and accommodate the shape of the cervix, resulting in bleeding.

Risk Factors

Placenta previa is dangerous if not detected early. However, it is also highly preventable once you get to know the risk factors.

  • Advanced maternal age. Women who are over the age of 35 years old are at an increased risk of developing placenta previa.
  • Multiple gestations. The uterus which has accommodated more than one fetus has an increased risk for placenta previa.
  • Increased parity. Women who have given birth to a lot of children have an increased chance of having placenta previa.
  • Past caesarean births. Giving birth via caesarean delivery predisposes the woman to placenta previa on her next childbearing.
  • Past uterine curettage. Scars from a past curettage can affect the implantation of the uterus and lead to placenta previa.

Types

These types of placenta previa are classified according to the degree of the opening that is covered by the placenta.

Types of Placenta Previa

  • Low lying placenta. The placenta implants in the lower portion instead of the upper portion of the uterus.
  • Marginal implantation. The placenta’s edge is nearing the cervical os.
  • Partial placenta previa. A portion of the cervical os is already covered by the placenta.
  • Total placenta previa. The placenta occludes the entire cervical os.

Signs and Symptoms

The following signs and symptoms for placenta previa must be detected immediately by the health care providers to avoid risking the life of the fetus.

  • Bright red bleeding. When the placenta is unable to stretch to accommodate the shape of the cervix, bleeding will occur suddenly that could frighten the woman.
  • Painless. Bleeding in placenta previa is not painless and may also stop as abruptly as it had begun.

Diagnostic Tests

To diagnose placenta previa, the patient must undergo the following diagnostic procedure.

  • Ultrasound. Early detection of placenta previa is always possible through ultrasonography. It is the most common and initial diagnostic test that could confirm the diagnosis.

Medical Management

Medical interventions are necessary to ensure that the safety of both mother and fetus are still intact.

  • Intravenous therapy. This would be prescribed by the physician to replace the blood that was lost during bleeding.
  • Avoid vaginal examinations. This may initiate hemorrhage that is fatal for both the mother and the baby.
  • Attach external monitoring equipment. To monitor the uterine contractions and record fetal heart sounds, an external equipment is preferred than the internal monitoring equipment.

Surgical Management

Surgical interventions are carried out once the condition of both the mother and the fetus has reached a critical stage and their lives are exposed to undeniable danger.

  • Cesarean delivery. Although the best way to deliver a baby is through normal delivery, if the placenta has obstructed more than 30% of the cervical os it would be hard for the fetus to get past the placenta through normal delivery. Cesarean birth is then recommended by the physician.

Nursing Management

Nurses also play a major role in the care of a woman with placenta previa. They are also entrusted with the outcome of the lives of both the mother and the child.

Nursing Assessment

  • Assess baseline vital signs especially the blood pressure. The physician would order monitoring of the blood pressure every 5-15 minutes.
  • Assess fetal heart sounds to monitor the wellbeing of the fetus.
  • Monitor uterine contractions to establish the progress of labor of the mother.
  • Weigh perineal pads used during bleeding to calculate the amount of blood lost.
  • Assist the woman in a side lying position when bleeding occurs.

Nursing Diagnosis

  • Fear related to outcome of pregnancy due to bleeding.

Nursing Care Plans

Main article: Placenta Previa Nursing Care Plans
For more nursing care plans, please visit our Nursing Care Plan page.

Nursing Interventions

  • Assess fetal heart sounds so the mother would be aware of the health of her baby.
  • Allow the mother to vent out her feelings to lessen her emotional stress.
  • Assess any bleeding or spotting that might occur to give adequate measures.
  • Answer the mother’s questions honestly to establish a trusting environment.
  • Include the mother in the planning of the care plan for both the mother and the baby.

Evaluation

  • Woman is able to discuss her concerns with the health care providers.
  • States that hearing the fetal heartbeat assures her of the baby’s safety.

One could move mountains just to save the lives of their mother and child. That is also true for health care providers. The conditions that affect the health of the mother and the baby can be conquered if both the support system and the health care providers are working as a team towards one measurable purpose: to save lives.

Practice Quiz for Placenta Previa

Just how much you’ve learned from our study guide about placenta previa? Take our 10-item quiz below and find out!

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Questions

1. Which of the following is the most common kind of placental adherence seen in pregnant women?

A. Accreta
B. Placenta previa
C. Percreta
D. Increta

2. A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?

A. Placenta previa
B. Abruptio placentae
C. Ectopic pregnancy
D. Spontaneous abortion

3. The nurse is caring for a client in labor. The external fetal monitor shows a pattern of variable decelerations in fetal heart rate. What should the nurse do first?

A. Change the client’s position.
B. Prepare for emergency cesarean section.
C. Administer oxygen.
D. Check for placenta previa.

4. A pregnant client is diagnosed with partial placenta previa. In explaining the diagnosis, the nurse tells the client that the usual treatment for partial placenta previa is which of the following?

A. Activity limited to bed rest
B. Platelet infusion
C. Immediate cesarean delivery
D. Labor induction with oxytocin

5. A nurse assists in the vaginal delivery of a newborn infant. After the delivery, the nurse observes the umbilical cord lengthen and a spurt of blood from the vagina. The nurse documents these observations as signs of:

A. Hematoma
B. Placenta previa
C. Uterine atony
D. Placental separation

6. A nurse in the postpartum unit is caring for a client who has just delivered a newborn infant following a pregnancy with placenta previa. The nurse reviews the plan of care and prepares to monitor the client for which of the following risks associated with placenta previa?

A. Disseminated intravascular coagulation
B. Chronic hypertension
C. Infection
D. Hemorrhage

7. A maternity nurse is preparing for the admission of a client in the 3rd trimester of pregnancy that is experiencing vaginal bleeding and has a suspected diagnosis of placenta previa. The nurse reviews the physician’s orders and would question which order?

A. Prepare the client for an ultrasound
B. Obtain equipment for external electronic fetal heart monitoring
C. Obtain equipment for a manual pelvic examination
D. Prepare to draw a Hgb and Hct blood sample

8. Maureen in her third trimester arrives at the emergency room with painless vaginal bleeding. Which of the following conditions is suspected?

a. Placenta previa
b. Abruptio placentae
c. Premature labor
d. Sexually transmitted disease

9. Tyra experienced painless vaginal bleeding has just been diagnosed as having a placenta previa. Which of the following procedures is usually performed to diagnose placenta previa?

a. Amniocentesis
b. Digital or speculum examination
c. External fetal monitoring
d. Ultrasound

10. The common normal site of nidation/implantation in the uterus is:

A. Upper uterine portion
B. Mid-uterine area
C. Lower uterine segment
D. Lower cervical segment

Rationale

1. Answer: A. Accreta

Placenta accreta is the most common kind of placental adherence seen in pregnant women and is characterized by slight penetration of myometrium. In placenta previa, the placenta does not embed correctly and results in what is known as a low-lying placenta. It can be marginal, partial, or complete in how it covers the cervical os, and it increases the patient’s risk for painless vaginal bleeding during the pregnancy and/or delivery process. Placenta percreta leads to perforation of the uterus and is the most serious and invasive of all types of accrete. Placenta increta leads to deep penetration of the myometrium.

2. Answer: B. Abruptio placentae

The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae.

3. Answer: A. Change the client’s position.

Variable decelerations in fetal heart rate are an ominous sign, indicating compression of the umbilical cord. Changing the client’s position from supine to side-lying may immediately correct the problem. An emergency cesarean section is necessary only if other measures, such as changing position and amnioinfusion with sterile saline, prove unsuccessful. Administering oxygen may be helpful, but the priority is to change the woman’s position and relieve cord compression.

4. Answer: A. Activity limited to bed rest

Treatment of partial placenta previa includes bed rest, hydration, and careful monitoring of the client’s bleeding.

5. Answer: D. Placental separation.

As the placenta separates, it settles downward into the lower uterine segment. The umbilical cord lengthens, and a sudden trickle or spurt of blood appears.

6. Answer: D. Hemorrhage.

Because the placenta is implanted in the lower uterine segment, which does not contain the same intertwining musculature as the fundus of the uterus, this site is more prone to bleeding.

7. Answer: C. Obtain equipment for a manual pelvic examination.

Manual pelvic examinations are contraindicated when vaginal bleeding is apparent in the 3rd trimester until a diagnosis is made and placental previa is ruled out. Digital examination of the cervix can lead to maternal and fetal hemorrhage. A diagnosis of placenta previa is made by ultrasound. The H/H levels are monitored, and external electronic fetal heart rate monitoring is initiated. External fetal monitoring is crucial in evaluating the fetus that is at risk for severe hypoxia.

8. Answer: A. Placenta previa

Placenta previa with painless vaginal bleeding.

9. Answer: D. Ultrasound

Rationale: Once the mother and the fetus are stabilized, ultrasound evaluation of the placenta should be done to determine the cause of the bleeding. Amniocentesis is contraindicated in placenta previa. A digital or speculum examination shouldn’t be done as this may lead to severe bleeding or hemorrhage. External fetal monitoring won’t detect a placenta previa, although it will detect fetal distress, which may result from blood loss or placenta separation.

10. Answer: A. Upper uterine portion

The embryo’s normal nidation site is the upper portion of the uterus. If the implantation is in the lower segment, this is an abnormal condition called placenta previa.