PLACENTA PREVIA

AGNES CECILIA ANGGOMAN

06-096

Multiparit
y

Prior
cesarean
delivery

Risk
factor

Prior
placenta
previa

Advanced
maternal
age

Smoking

Symptoms
the acute onset of bright-red vaginal
bleeding, which is usually painless. It is
often accompanied by decreased fetal
movement

Fetal malpresentation is common,

because the placenta prevents
engagement of the presenting part. It
may be an incidental finding on routine
ultrasound

DIAGNOSIS

Ultrasound

Transperineal
and/or transvaginal

Serial ultrasound
examinations are
useful to follow
placental location,
fetal presentation
(malpresentation is
common), and
possibly fetal
growth (although
placenta previa is
not associated with
intrauterine growth
restriction)

CAUSES
Placentia previa refers to implantation of the

placenta over the cervical os in advance of

the fetal presenting part. It complicates in 200
pregnancies, and accounts for 20% of all
cases of antepartum hemorrhage
Other causes of antepartum hemorrhage
include placental abruption (see chapter 47),
vasa previa(see chapter 67), early labor, and
genital tract lesions (cervical polyps or
erosions)

CAUSES
When a woman presents with antepartum

hemorrhage, pelvic examination should be

avoided until placenta previa is excluded on
ultrasound.
Other causes of antepartum hemorrhage
include placental abruption (see chapter 47),
vasa previa(see chapter 67), early labor, and
genital tract lesions (cervical polyps or
erosions).

MANAGEMENT IN THE SETTING OF

PLACENTA PREVIA
The goal of antepartum management in the setting

of placenta previa is to maximize fetal maturation

while minimizing risk to mother and fetus.
Nonreassuring fetal testing (fetal distress) and
excessive maternal hemorrhage are contraindications
to expectant management, and may necessitate
immediate cesarean irrespective of gestational age.
Outpatient management may be an option for
women with a single small bleed if they can comply
with restrictions on activity and maintain proximity to
a hospital. Placenta previa may resolve with time,
thereby permitting vaginal delivery.

Vaginal delivery is rarely appropriate in the

setting of placenta previa, but may be

indicated in the setting of intrauterine fetal
demise, fetal malformation(s) incompatible
with life, advanced labor with engagement of
the fetal head and minimal vaginal bleeding,
or an indicated delivery with a previable fetus