Placenta Previa

Placenta previa is an improperly implanted placenta in lower uterine segment caused by multiparity, presence of myomas, previous CS, uterine abnormalities.

• spotting (during first and second trimester)
• bleeding that is PAINLESS, profuse and sudden (during third trimester or at the end of second trimester). NOTE: bleeding may not occur until onset of cervical dilatation causing the placenta to loosened from the uterus. Total placenta previa has more earlier profuse bleeding.
• ultrasound showing the location and degree of obstruction

Classification of Placenta Previa

• complete (total or central)
• partial (implantation occludes a portion of the cervical os)
• marginal (placenta edge approaches cervical os)
• low lying (lower rather than upper implantation)

Diagnosis for Placenta Previa

• ultrasound
• identification of fetal position
• hemoglobin and hematocrit count

Nursing Implications for Placenta Previa

•  BLEEDING IS AN EMERGENCY! (Fetal oxygen supply may be compromised and premature labor may begin
• strict bed rest with oxygen if prescribed
• close monitoring of bleeding and maternal and fetal well-being
• determine fetal lung maturity by amniocentesis - L/S ration
• preventive shock measures
• positioning: sidelying or trendelenburg for 72 hrs (some advocate sitting position)
• NO IE OR RECTAL exam - it may initiate massive hemorrhage! (if necessary MUST be done in the OR with double set up)
• keep IV line and make blood available

NOTE: greater risk for post-partum hemorrhage. Endometritis is also common.


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