Placenta Previa

Definition/Etiology:

Implantation of the placenta in the lower uterine segment or over the internal os.

Pathophysiology:

As the fetus grows, there is more pressure on the placenta. A placenta in this position has the potential to bleed through the cervix causing potential hemorrhage and risk to the fetus. Underlying etiology is unknown.

Risk factors include:

• Advanced maternal age
• multifetal gestation
• smoking
• previous c-section
• hx of previous placenta previa

Clinical Presentation:

• Sudden PAINLESS BRIGHT red bleeding in the second or third trimester
• Uterus will be soft and non-tender (uterus is not the problem, placenta is)
• May have increased fundal height due to the placenta pushing baby up
• Signs of maternal shock may be present

Collaborative Management:

Large bore IVs for fluid resuscitation

Get labs:

• CBC
• BMP
• Type and Cross
• ABO

Evaluation | Patient Monitoring | Education:

• Hemodynamic monitoring – watch for shock!
• Fetal monitoring
• VAGINAL EXAM = BIG NO NO
  • Placenta is sitting on the top of the cervix so if you open the cervix, you could further disrupt the placenta
• Usually results in a c-section

Linchpins: (Key Points)

• Painless, bright red bleeding
• Bedrest, no intercourse and no digital exams!
• Gynecological emergency!!
• Usually results in a c-section