Previous placenta previa

Multiple births
Endometritis
VBAC (vaginal birth after cesarean delivery)
Lifestyle (smoking, etc.)
 IMPLANTATIO
N

Accret
a

Total P. Previa

Partial P. Previa

Marginal P. Previa
ONSET OF
LABOR
Promote contraction
Altered Tissue Perfusion related to
excessive bleeding causing fetal
compromise
Fluid volume deficit related to
excessive bleeding
Risk for infection related to
excessive blood loss
Anxiety related to excessive
bleeding
 Fear related to outcome of
pregnancy after episodes of
bleeding
 MEDICAL MANAGEMENT SURGICAL MANAGEMENT

• IV access • Amniocentesis
• Laboratory examinations • CS section
• Blood typing and cross
matching
• Admin. Betamethasone
(Celestone)
CHARACTERISTIC PLACENTA PREVIA ABRUPTIO PLACENTA
ONSET Third trimester commonly Third trimester
@32-36wks
BLEEDING Mostly external, small to May be concealed, external
profuse in amount, bright red dark hemorrhage or bloody
amniotic fluid
PAIN AND UTERINE Usually absent; uterus soft Usually present; irritable
TENDERNESS uterus, progresses to board
like consistency
FETAL HEART TONE Usually normal Maybe irregular or absent
PRESENTING PART Usually not engaged May be engaged
SHOCK Usually not present unless Moderate to severe depending
bleeding is excessive on extent of concealed and
external hemorrhage

DELIVERY Delivery may be delayed Immediate delivery, usually by

depending on size of fetus and CS section
amount of bleeding
If the placenta begins to detach during pregnancy, there is bleeding from these vessels.
The larger the area that detaches, the greater the amount of bleeding
Destruction of the placental tissues
 NOTE:
Small amount of blood goes out to the vagina (not an indication of the severity of condition)
Ineffective tissue perfusion (placental) related to
excessive bleeding, hypotension, and decreased
cardiac output, causing fetal compromise
Acute Pain related to increase
uterine activity
Fluid volume deficit related to
excessive bleeding
Risk for infection related to
excessive blood loss
 Fear related excessive bleeding
procedures and unknown outcome
 MEDICAL MANAGEMENT SURGICAL MANAGEMENT

• IV administration of
fibrinogen or •CS section
cryoprecipitate
• Laboratory examinations