PLACENTA PREVIA

Definition:
•Is an abnormal low implantation of the placenta in proximity to the internal cervical os.
•Placenta previa is a condition in which the placenta attaches to the uterine wall in the lower portion of the uterus
and covers all or part of the cervix.

Classification of Placenta Previa

1.Total Previa- the placenta completely covers the internal cervical os.
2.Partial Previa- the placenta covers a part of the internal cervical os.
3.Marginal Previa- the edge of the placenta lies at the margin of the internal cervical os and may be exposed
during dilatation.
4.Low-lying placenta- the placenta is implanted in the lower uterine segment but does not reach to the internal os
of the cervix.

Risk factors
1.Advanced maternal age
2. multiparity
3.previous uterine surgery
4.large placenta (multiple gestation, erythroblastosis)
5. maternal smoking

True placenta previa at term is very serious. Complications for the baby include:
•Problems for the baby, secondary to acute blood loss
•Intrauterine growth retardation due to poor placental perfusion
•Increased incidence of congenital anomalies

Signs and Symptoms

Signs and symptoms of placenta previa vary, but the most common symptom is painless bleeding during the third
trimester. Other reasons to suspect placenta previa would be:
• Premature contractions
• Baby is breech, or in transverse position
• Uterus measures larger than it should according to gestational age

Management:
1.may be given drugs that can prevent premature labor or birth example is progesterone.
2.Ultrasound exams to determine migration of an early diagnosed previa or classification of the previa as total,
partial, marginal, or low-lying.
3.With a small first bleed, client may sent home on bed rest if she can return to hospital quickly.

4.If bleeding is more profuse client is hospitalized on bed rest with BRP, IV access; labs: Hgb and Hct, urinalysis,
blood group and type and cross match for 2 units of blood hold, possible transfusions; goal is to maintain the
pregnancy fetal maturity.
5.No vaginal exams are performed except under special conditions requiring a double set-up for immediate
cesarean birth should hemorrhage result.
6.Low lying or marginal previas may allowed to deliver vaginally if the fetal head acts as tamponade to prevent
hemorrhage.
7.Cesarean birth, often with vertical uterine incision, is used for total placenta previa.
8.Steroid shots may be given to help mature the baby's lungs.

*Fluid Volume Deficient r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Possible Nursing Diagnosis
Risk for Impaired Fetal Gas Exchange r/t Disruption of Placental Implantation
Fluid Volume Deficit r/t Active Blood Loss Secondary to Disrupted Placental Implantation
Active Blood Loss (Hemorrhage) r/t Disrupted Placental Implantation
Fear r/t Threat to Maternal and Fetal Survival Secondary to Excessive Blood Loss
Activity Intolerance r/t Enforced Bed Rest During Pregnancy Secondary to Potential for Hemorrhage
Altered Diversional Activity r/t Inability to Engage in Usual Activities Secondary to Enforced Bed Rest and
Inactivity During Pregnancy