Introduction: The placenta is implanted in the lower uterine segment near or over the internal cervical os.

The degree to which the internal cervical os is covered by the placenta has been used to classify four types of placenta previa; total, partial, marginal and lowlying. In total previa the internal os is entirely covered by the placenta. Partial placenta previa implies incomplete coverage of the internal os. Marginal placenta previa indicates that only an edge of the placenta extends to the margin of the internal os. And the last is the low lying placenta has been used when the placenta is implanted in the lower uterine segment but not reach the os. The more descriptive classification that includes placenta previa is in the third trimester. The incidence of placenta previa is approximately 0.5% of births. The most important risk factors are previous placenta previa, previous cesarean birth, and suction curettage for miscarriage or induced abortion, possible related to endometrial scarring. The risk also increases with multiple gestations because of the larger placental area, closely spaced pregnancies, advanced maternal age older than 34 years, African or Asian ethnicity, male fetal sex, smoking, cocaine use, multiparity, and tobacco use. Classification of Placenta Previa: 1. Total Previa- the placenta completely covers the internal cervical os. 2. Partial Previa- the placenta covers a part of the internal cervical os. 3. Marginal Previa- the edge of the placenta lies at the margin of the internal cervical os and may be exposed during dilatation. 4. Low-lying placenta- the placenta is implanted in the lower uterine segment but does not reach to the internal os of the cervix.

Predisposing Factors: 1. 2. 3. 4. 5. 6. Multiparity (80% of affected clients are multiparous) Advanced maternal age (older than 35 years old in 33% of cases Multiple gestation Previous Cesarean birth Uterine Incisions Prior placenta previa ( incidence is 12 times greater in women with previous placenta previa)

Complications for the baby include:

Problems for the baby, secondary to acute blood loss Intrauterine growth retardation due to poor placental perfusion Increased incidence of congenital anomalies

Clinical Manifestations:

Painless vaginal bleeding > occurs after 20 weeks of gestation, bright red in color associated with the stretching and thinning of the lower uterine segment that occurs in third trimester. Adequately contract and stop blood flow from open vessels. Stop blood flow from open vessels Decreasing urinary output

Normal Placenta During Childbirth

Process of placental growth and uterine wall changes during pregnancy 1. The placenta grows with the placental site during pregnancy. 2. During pregnancy and early labor the area of the placental site probably changes little, even during uterine contractions. 3. The semirigid, noncontractile placenta cannot alter its surface area. Anatomy of the uterine/placental compartment at the time of birth 1. The cotyledons of the maternal surface of the placenta extend into the decidua basalis, which forms a natural cleavage plane between the placenta and the uterine wall.

2. There are interlacing uterine muscle bundles, consisting of tiny myofibrils, around the branches of the uterine arteries that run through the wall of the uterus to the placental area. 3. The placental site is usually located on either the anterior or the posterior uterine wall. 4. The amniotic membranes are adhered to the inner wall of the uterus except where the placenta is located

1-13. PLACENTA PREVIA a. Placenta previa is hemorrhage resulting from the low implantation of the placenta on the interior uterine wall. It is common in multiparous mothers. The cause is unknown. b. There are three types of placenta previa. Each type is identified according to the degree to which condition is present (see figure 1-5). (1) Total placenta previa. This occurs when the placenta completely covers the internal os. (2) Partial placenta previa. This occurs when the placenta partially covers the internal os. (3) Low implantation of placenta previa. This occurs when the placenta is attached at the opening or border to the cervical os, but not covering it.

Figure 1-5. Types of placenta previa. http://www.brooksidepress.org/Products/Obstetric_and_Newborn_Care_II/lesson_1_Section_1A.htm

http://www.moondragon.org/obgyn/pregnancy/placenta.html

Placenta Previa Anatomy

To better understand placenta previa, it helps to understand the anatomy of the uterus, cervix, and Fallopian tubes. The placenta is attached to the wall of the uterus. It delivers oxygen and nutrients from the mother's bloodstream to the fetus, during the pregnancy. The normal position of the placenta within the uterus is away from the cervix. If the placenta grows too close to the cervix, placenta previa can result. Anatomy of the female reproductive tract includes:

The uterus, cervix, and vaginal canal The bladder The fallopian tubes: o These paired structures connect each ovary to the uterus The ovaries: o One on each side of the uterus. A normal adult ovary is about the size of an unshelled almond Female organs during a pelvic examination

The fetus grows within the amniotic sac within the uterus:

The fetus within the amniotic sac The near term fetus within the uterus Ultrasound of fetus and placenta

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