NCM 102 RLE 2012.

Placenta Previa

PLACENTA

PREVIA

Placenta previa is a complication of pregnancy, in which the placenta is located near or over the interior cervical os. Premature separation of abnormally low implanted placenta. Is an abnormally loew implantation of the placenta in the proximity to the internal cervical os. 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. RISK FACTORS Multiparity Decreased vascularity in the lower uterine segment as in scarring and tumor Increased age: above 35 years Previous uterine surgery Large placenta (multiple gestation, erythroblastosis)

TYPES Low Lying or Marginal The placental edge lies on or near the cervical os but more than 3cm from the cervical os

Partial or Incomplete

The placenta lies within 3 cm of the cervical os and partly covers internal os

Central or total or complete

The centre of the placenta lies directly over the cervical os, totally obstructing the birth canal

SIGNS AND SYMPTOMS Painless vaginal bleeding (fresh, bright red) in the 3rd trimester or 7th month Uterus soft or flaccid to intermitted hardening if in labor Intermittent pain if it happens in labor secondary to uterine contractions Bleeding may be slight or profuse which may come after activity, coitus or internal examination Premature contractions Baby is breech or in transverse position Uterus measures larger than it should accdg to gestational age INCIDENCE Most common cause of bleeding in the third trimester; occurs in 1:150 to 200 pregancies.

1|P age

Facilitators: Muralla.Lorca.Tortola.Gito.Ronolo

NCM 102 RLE 2012. Placenta Previa

DIAGNOSTIC TEST 1. Ultrasound/Ultrasonography (Confirmatory diagnostic test) a. The most important, simplest and safest procedure for placenta previa b. It locates the placenta with precision and determines the type of previa involved

TREATMENT 1. EXPECTANT MANAGEMENT/ Watchful waiting: if the mother if not in labor; fetus is premature, stable and not in distress; not severe bleeding 2. AMNIOTOMY: Artificial rupture of the bag or water causes fetal head to descend causing mechanical pressure at placental site 3. DOUBLE SETUP/ One set for vaginal delivery and for classical CS: prepared for IE in suspected placenta previa in the following gestation: a. Term gestation b. Mother in labor and progressing well c. Mother and fetus are stable d. NOTE: if the woman is not in labor or in shock, and or the fetus is distressed only one set is prepared which is the classical cesarean section set-up. 4. DELIVERY: if conditions for watchful waiting are absent: a. Vaginal delivery if birth canal is not obstructed b. CS if placental placement prevents vaginal birth. c. NOTE: In previa, classical CS is indicated as the lower uterine segment is occupied by the placenta. Future pregnancies will be terminated by another CS because classical CS scar is a contraindication to vaginal delivery (leading cause of uterine rupture)

COMPLICATIONS For the mother 1. Hemorrhage 2. Prematurity 3. Obstruction of birth canal For the baby 1. Intrauterine growth retardation due to poor placental perfusion 2. Increased incidence of congenital anomalies

NURSING MANAGEMENT 1. 2. 3. 4. 5. 6. 7. 8. Maintain bed rest-left lateral recumbent with a head pillow Do not perform IE or vaginal examination Careful assessments: V/S bleeding, onset/progress of labor, FHT Prepare client for diagnostic ultrasonography Institute shock measures as necessary Provide psychological and physical comfort Prepare for conservative management and double set-up or a classical CS Observe for bleeding after delivery

REFERENCE: Rosalinda Salustiano (2009) Essential procedures for safe maternity care
2|P age Facilitators: Muralla.Lorca.Tortola.Gito.Ronolo