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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.
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
True placenta previa at term is very serious. Complications for the baby include:
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
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.
1. The cotyledons of the maternal surface of the placenta extend into the decidua basalis, which forms a natural
cleavage plane between the placenta and the uterine wall.
2. There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the branches of the uterine
arteries that run through the wall of the uterus to the placental area.
3. The placental site is usually located on either the anterior or the posterior uterine wall.
4. The amniotic membranes are adhered to the inner wall of the uterus except where the placenta is located
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
PATHOPHYSIOLOGY OF PLACENTA PREVIA
Painless Vaginal
Bleeding
Ultrasound
Risk Factors
Bleeding Stops
Fetus Stable
Bed Rest
Observe
↓ Urine Output Pale, cool skin
Complications:
Congenital Anomalies
Maternal Mortality (rare)
Intrauterine Growth Retardation
(IGR)
Determine if Pt. has any objections to blood Pt. may have religious beliefs related to accepting
transfusions- inform physician. blood products
Administer blood transfusion as ordered with To provides replacement of blood components and
client consent. volume
Monitor closely for transfusions reaction To prevent for Potentially life-threatening allergic
reaction may result from incompatible blood
Provide emotional support; keep Pt. and family
informed of findings and continuing plan Support and information decrease anxiety and help
of care. Pt. and family to anticipate what might happen next.