Placenta Previa

Placenta previa is a life-threatening condition that presents in three forms (Fig. 21-5). When the cervical os is completely covered with placenta, it is classified as a complete or total placenta previa. Partial placenta previa occurs when the placenta covers a portion of the cervical os. A marginal placenta previa is one that extends just to the edge of the cervix. Placental implantation in the lower uterine segment is termed low-lying placenta. The incidence of placenta previa is about 1 in 200 to 250 pregnancies and is associated with potentially serious consequences from hemorrhage, separation of the placenta, or emergency cesarean delivery (Iyasu et al., 1993).

Placenta previa is usually diagnosed when the patient complains of painless vaginal bleeding in the third trimester. A smaller number of patients present with excessive bleeding in labor. Usually the initial bleeding is not profuse enough to be fatal and spontaneously ceases, only to recur later. The average first bleed occurs at 27 to 32 weeks of gestation. Women with a centrally implanted placenta previa tend to have earlier episodes of bleeding, which are more severe. Another suspicious aspect of the history includes an abnormal lie, in particular transverse or breech presentation.

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