What am i? ❖ Three types: Marginal, partial,

and total❖ Common cause of bleeding during

the second half of pregnancy❖ Good maternal prognosis if

hemorrhage can be controlled❖ Usually necessitates pregnancy

termination if bleeding is heavy❖ Fetal prognosis dependent on

gestational age and amount of blood lost; risk of death greatly reduced by frequent monitoring and prompt management

Patho Improper implantation of the placenta in the lower uterine segment has caused partial or total coverage of the cervical os.With development of the lower uterine segment and gradual changes in the cervix during the third trimester, shearing forces at the attachment site lead to partial detachment and bleeding.

Risk Factors❖ Advanced maternal age (over age 35)❖ Defective vascularization of the decidua❖ Endometriosis❖ Multiparity❖ Infertility treatments❖ Multiple pregnancy❖ Previous uterine surgery or cesarean birth❖ Smoking❖ Male fetus❖ Cocaine use❖ History of placenta previa❖ High altitudes❖ Uterine abnormalities inhibiting normal

embryonic implantation (such as prior curettage or the presence of uterine fibroids)

complications❖ Cord being the presenting part, possible

cord prolapse❖ Fetal hypoxia or blood loss❖ Preterm delivery❖ Dystocia❖ Anemia❖ Hemorrhage❖ Abruptio placentae❖ Disseminated intravascular coagulation❖ Shock❖ Placenta accreta, increta, percreta❖ Intrauterine growth restriction❖ Abnormal fetal presentation❖ Kidney damage❖ Cerebral ischemia❖ Maternal or fetal death

Assessment❖ Painless bleeding❖ Soft, nontender uterus❖ Fetal malpresentation❖ Minimal descent of fetal

presenting part❖ Good fetal heart tones❖ Possible contractions

Medications❖ I.V. fluids, such as lactated Ringer solution

or normal saline solution, using a large-bore catheter

❖ Oxygen❖ Fresh frozen plasma and platelets, as

necessary, for coagulation problems❖ Tocolytics, such as terbutaline sulfate,

calcium channel blockers, or magnesium sulfate short-term to halt preterm labor and to allow time for doses of betamethasone dipropionate (Diprolene)

❖ Betamethasone dipropionate to enhance fetal lung maturity if less than 34 weeks' gestationInterventions

❖ Pad counts, the patient should not saturate more than one pad an hour.

❖ Monitor blood counts ❖ Monitor fetal heart tones❖ Monitor contractions❖ Prepare for c-section ❖ Do not perform cervical exams

Complications : Placenta Previa