- Placenta is improperly implanted in the uterus and covers the cervix
- The placenta is usually implanted at the top or side portion of the uterus
- Placenta previa is when the placenta covers the cervix
- Complete – cervix is completely covered
- Partial – not fully covering the cervix
- Marginal – on the edge of the cervix
- Painless, bright red vaginal bleeding
- How much?
- Placenta location assessed on ultrasound
- Vaginal exams are contraindicated
- How it is managed depends on age of fetus, degree of placenta previa and if the fetus or mother are in distress
- If it’s marginal, vaginal delivery can be attempted
- C-section may be indicated otherwise
- Report any vaginal bleeding to provider
- May require bed rest in later weeks for known previa
In this lesson I will explain placenta previa, what it means for the patient and your role in the care.
So where is the placenta supposed to be? The placenta is supposed to be implanted in the uterus at the fundus but in previa it is implanted wrong. It is in the lower portion. It can be complete where it covers the cervix completely. Partial is where it covers part of the cervix and marginal is where it is right on the edge of the cervix. You can see in this image the cervix is completely covered. This is a complete previa. Partial would be over part of the cervix and marginal would be over to the side.
Now let’s look at the assessment. There is painless, bright red vaginal bleeding. We need to know how much. So we can ask the patient how many pads have you changed. Remember this is painless bleeding where an abruption is painful so the patient might not be complaining as much. In addition to asking how many pads we can ask about when it started and the consistency of it. Placenta location is assessed on ultrasound. We have to see where the location is located. Is it in the upper uterus at the fundus where it should be? Is it completely covering the cervix. Is it marginal or partial?
Our management for this patient will involve a few things. First of all vaginal exams are contraindicated. We don’t want to have a hand in there irritated the cervix and causing more bleeding, right? So contraindicated. Monitoring of the bleeding amount and maternal vitals as well as fetal heart rate are done. There are times that we have patients that are on our unit for a week or more being watched for bleeding. So they stay in a bed and pad counts and weights are done to see the amount of blood loss. Fetal heart rate assessment is watched while they are on the unit and if at any moment something goes wrong then that is it. We are done monitoring and they are going to the OR for an emergent delivery. So sometimes that happens and other times we have patients that are on the unit being watched and then the bleeding slows down and resolves and they get to go home. So our other management will depend on how this looks and the degree of the previa. So delivery by cesarean is our most likely method if it is complete or partial previa. If it is only marginal then they might attempt a vaginal delivery. You should just focus on remembering cesarean section for delivery because it is the most likely and safest. If it is in a test question it is there for a reason so c-section for delivery.
Education for this patient will involve having the patient report any bleeding. She might need to come in for monitoring of the bleeding. Nurses will measure the bleeding to assess the loss. So they will weigh the bloody pads. 1 gm equals 1 ml of blood loss. This is how they quantify how much is lost. Bed rest may also be required for this patient to help slow the bleeding.
Our concepts are perfusion and safety. There is a concern of perfusion to the fetus with the blood loss occurring and the fetus not getting all the nutrients and some of the life line is being shed and of course safety of mom and baby with the blood loss.
Ok what have we learned about placenta previa? It is when the placenta attaches low in the the uterus which is the wrong place! It is supposed to attach towards the top. In previa it is too low and, sometimes covers the cervix. The patient’s symptoms will be painless bleeding! This will not hurt, Since the placenta is low delivery is by c-section usually. So if that placenta is completely cover the cervix we can not do a vaginal delivery because we don’t want the placenta, the life line to deliver before the baby!
Make sure you check out the resources attached to this lesson and compare this with placental abruption because these two can get confused by their symptoms. Now, go out and be your best selves today. And, as always, happy nursing.