Placenta previa
Complete or total
The cervical os is completely covered by the placental attachment.
Incomplete or partial
The cervical os is only partially covered by the placental attachment
Low-lying
The exact relationship of the placenta to the internal os has not been determined
Marginal
The placenta is attached in the lower uterine segment but does not reach the cervical os.
What is placenta previa?
occurs when the placenta abnormally implants in the lower segment of the uterus near or over the cervical os instead of attaching to the fundus. The abnormal implantation results in bleeding during the third trimester of pregnancy as the cervix begins to dilate and efface
Placenta Previa: CLIENT EDUCATION
● Adhere to bed rest ● Do not insert anything into the vagina because it can worsen bleeding
Placenta Previa: NURSING CARE
● Assess for bleeding, leakage, or contractions. ● Assess fundal height. ● Refrain from performing vaginal exams (can exacerbate bleeding). ● Administer IV fluids, blood products, and medications as prescribed. Corticosteroids, such as betamethasone, promote fetal lung maturation if early delivery is anticipated (cesarean birth). ● Have oxygen equipment available in case of fetal distress.
Placenta Previa: LABORATORY TESTS
● Hgb and Hct for blood loss assessment ● CBC ● Blood type and Rh ● Coagulation profile ● Kleihauer-Betke test (used to detect fetal blood in maternal circulation)
Placenta Previa: EXPECTED FINDINGS
● Painless, bright red vaginal bleeding during the second or third trimester ● Uterus soft, relaxed, and nontender with normal tone ● Fundal height greater than usually expected for gestational age ● Fetus in a breech, oblique, or transverse position ● Reassuring FHR ● Vital signs within normal limits ● Decreasing urinary output, which can be a better indicator of blood loss
Placenta Previa: RISK FACTORS
● Previous placenta previa ● Uterine scarring (previous cesarean birth, curettage, endometritis) ● Maternal age greater than 35 years ● Multifetal gestation ● Multiple gestations or closely spaced pregnancies ● Smoking
Placenta Previa: DIAGNOSTIC PROCEDURES
● Transabdominal or transvaginal ultrasound for placement of the placenta ● Fetal monitoring for fetal well-being assessment
