Placenta previa is an obstetric complication in which the placenta is attached to the uterine wall close to or covering the cervix. sometimes occur in the later part of the first trimester, but usually during the second or third trimester. It is a leading cause of antepartum haemorrhage.

SYMPTOM:

The main symptom of placenta previa is sudden bleeding from the vagina. Some women have cramps, too. The bleeding often starts near the end of the second trimester or beginning of the third trimester. Bleeding may be severe. It may stop on its own but can start again days or weeks later. Labor sometimes starts within several days of heavy bleeding. Sometimes, bleeding may not occur until after labor starts.

DIAGNOSIS:

Women with placenta previa often present with painless, bright red vaginal bleeding. This bleeding often starts mildly and may increase as the area of placental separation increases. Praevia should be suspected if there is bleeding after 24 weeks of gestation.

There are four types of placenta praevia. The first two of these are the most common:

· Type I or low lying: The placenta encroaches the lower segment of the uterus but does not infringe on the cervical os.

· Type II or marginal: The placenta touches, but does not cover, the top of the cervix.

· Type III or partial: The placenta partially covers the top of the cervix.

· Type IV or complete: The placenta completely covers the top of the cervix.

Received on 01.01.2013 Modified on 20.01.2013

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 134-135

The image bellow shows the position of a normal placenta and then what partial and major placenta praevia look like.

RISK FACTORS:

The following have been identified as risk factors for placenta praevia:

· Previous placenta previa, caesarean delivery, D &C used for incomplete or missed miscarriage, abortion, to treat or investigate heavy bleeding or other diagnostic purposes.

· Use of alcohol and smoking during pregnancy.

· Who have had previous pregnancies, especially a large number of closely spaced pregnancies, are at higher risk.

· Women who are younger than 20 and women older than 30 are at increasing risk as they get older.

· Women with a large placentae from twins or erythroblastosis at higher risk.

· Placenta previa is itself a risk factor of placenta accreta.

TREATMENT:

Health care provider will carefully consider the risk of bleeding against early delivery of baby. After 36 weeks, delivery of the baby may be the best treatment. Nearly all women with placenta previa need a c-section. If the placenta covers all or part of the cervix, a vaginal delivery can cause severe bleeding. This can be deadly to both the mother and the baby. If the placenta is near or covering a part of the cervix, doctor may recommend:

· Reducing activities

· Bed rest

· Pelvic rest, which means no sex, no tampons, and no douching

Nothing should be placed in the vagina. patient may need to stay in the hospital so health care team can closely monitor mother and baby. Other treatments are:

· Blood transfusions

· Medicines to prevent early labor

· Medicines to help pregnancy continue to at least 36 weeks

· Shot of special medicine called rhogam if blood type is Rh-negative

· Steroid shots to help the baby's lungs mature

An emergency c-section may be done if the bleeding is heavy and cannot be controlled.

PRECAUTIONS IN PLACENTA PRAEVIA:

If patient diagnosed after week 20, but not bleeding, doctor may advise not to do anything strenuous. This could include household chores, lifting and moving heavy furniture, carrying older toddler, doing any vigorous exercise and even sex.

It's a good idea to take care while commuting, as our roads are often full of potholes and steep bumpy speed breakers. Try to limit the use of auto rickshaws, cycle rickshaws and buses during peak traffic hours. Use own transport if possible, or hire a taxi which will allow to manage the speed and better maintained routes.

Talk to doctor and other mums with placenta praevia. Getting as much information as they can, our community is a great place to meet other mums who may be in the same stage as you.

Most importantly stay positive and surround self with things love such as family, friends, a good book, DVDs of favorite movies, a cup of tea/coffee, or music.

REFERENCES:

1. Francois KE, Foley MR. Antepartum and postpartum hemorrhage. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:Chap 18.

2. Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 176.

3. [http://www.uabhealth.org/15407/www.uabhealth.org"]. University of Alabama at Birmingham. Retrieved 2010-01-11.

Received on 28.04.2013 Modified on 17.05.2013

Asian J. Nur. Edu. and Research 3(3): July-Sept., 2013; Page 129-133

Placenta Previa and Its Management

Mrs. Veena Rajput

Reader, Shri Shankaracharya College of Nursing, Bhilai (C.G.)

PRECAUTIONS IN PLACENTA PRAEVIA: