Placenta Previa
Maternity
Pathophysiology
This is the abnormal implantation of the placenta over the cervix either
completely or partially at the bottom of the uterus. As you know, the
cervix is the door to the baby condo which is now blocked by the placenta,
making a normal vaginal delivery impossible.
As pregnancy progresses, the placenta grows in size & can migrate away from
the cervical opening. This means it may resolve on its own by the 3rd trimester.
Therefore, additional ultrasounds are typically performed closer to the time
of delivery - around 36 weeks to reassess placental location.
Complete previa
Partial previa
Causes & Risk factors
Scar tissue
Previous cesarean section, abortion,
uterine surgery, multiparity (twins, triplets)
Maternal age 35 or older
Smoking
Age 35 or older
ATI Question
… at 24 weeks … painless, bright red vaginal bleeding.
Which of the following conditions does the nurse suspect?
Signs & Symptoms
Placenta previa
HESI Question
Painless vaginal bleeding
“bright red” NCLEX TIP
Decreased H&H
... after 20 weeks... painless bright red vaginal bleeding:
Placenta previa
Kaplan Question
… at 29 weeks … reporting vaginal bleeding… indicative
of a placenta previa?
“The bleeding scares me, other than that, I feel fine”
Interventions
Education
NCLEX TIPS
Anticipate Blood Transfusion
Initiate 2 large-bore IV catheters
Draw blood for type and screen
Pad counts to assess for bleeding
Electronic fetal monitoring
Cesarean birth before the onset of labor
Betamethasone: preterm newborns for
lung development ATI
NO vaginal exams, “digital exams”
Saunder’s Question
... placenta previa… question which
prescription?
Obtain equipment for a manual
pelvic examination
NCLEX TIPS
Pelvic rest (no sex, no douching,
no vaginal examination)
Additional ultrasound around 36 weeks
gestation & prior to onset of labor
Discharge home
Only if bleeding stops and
fetal status is reassuring
Instruct to return to the hospital
if bleeding occurs
Bedrest: decrease physical activity
Scheduled cesarean birth before
onset of labor
Obtain equipment
for a manual pelvic
examination