Placenta Previa Clinical Presentation

  • Author: Saju Joy, MD, MS; Chief Editor: Carl V Smith, MD   more...
 
Updated: Feb 25, 2010
 

History

The classic presentation of placenta previa is painless vaginal bleeding.

  • Nearly two thirds of symptomatic patients present before 36 weeks' gestation, with half of these patients presenting before 30 weeks' gestation.
  • This hemorrhage often stops spontaneously and then recurs with labor.
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Physical

  • Any pregnant patient beyond the first trimester who presents with vaginal bleeding requires a speculum examination followed by diagnostic ultrasound, unless previous documentation confirms no placenta previa.
  • Because of the risk of provoking life-threatening hemorrhage, a digital examination is absolutely contraindicated until placenta previa is excluded.
  • Uterine activity monitoring reveals that approximately 20% of patients have concurrent contractions with their bleeding.
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Causes

  • Hemorrhaging, if associated with labor, would be secondary to cervical dilatation and disruption of the placental implantation from the cervix and lower uterine segment. The lower uterine segment is inefficient in contracting and thus cannot constrict vessels as in the uterine corpus, resulting in continued bleeding.
  • Advancing age (>35)
  • Multiparity
  • Infertility treatment
  • Multiple gestation (larger surface area of the placenta)
  • Erythroblastosis
  • Prior uterine surgery
  • Recurrent abortions
  • Nonwhite ethnicity
  • Low socioeconomic status
  • Short interpregnancy interval
  • Smoking
  • Cocaine use
  • Other causes include digital exam, abruption (pre-eclampsia, chronic hypertension, cocaine use, etc) and other causes of trauma (eg, postcoital trauma).
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Contributor Information and Disclosures
Author

Saju Joy, MD, MS  Associate Director, Division Chief of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Carolinas Medical Center

Saju Joy, MD, MS is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Deborah Lyon, MD  Director, Division of Gynecology, Associate Professor, Department of Obstetrics and Gynecology, University of Florida Health Science Center at Jacksonville

Deborah Lyon, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of American Medical Colleges, Association of Professors of Gynecology and Obstetrics, and Florida Medical Association

Disclosure: Nothing to disclose.

Ryan A Stone, MD  Fellow, Department of Obstetrics and Gynecology, Maternal-Fetal Medicine Section, Wake Forest University Health Sciences

Ryan A Stone, MD is a member of the following medical societies: Academic Pediatric Association, American College of Obstetricians and Gynecologists, American Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard S Legro, MD  Professor, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology, Pennsylvania State University College of Medicine; Consulting Staff, Milton S Hershey Medical Center

Richard S Legro, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, Endocrine Society, Phi Beta Kappa, and Society of Reproductive Surgeons

Disclosure: Korea National Institute of Health and National Institute of Health (Bethesda, MD) Honoraria Speaking and teaching; Greater Toronto Area Reproductive Medicine Society (Toronto, ON, CA) Honoraria Speaking and teaching; American College of Obstetrics and Gynecologists (Washington, DC) Honoraria Speaking and teaching; National Institute of Child Health and Human Development Pediatric and Adolescent Gynecology Research Think Tank Panel (Bethesda, MD) Honoraria Speaking and teaching; University of Illinois (Chicago, IL) Honoraria Speaking and teaching; Georgetown University Hospital (Washington, DC) Honoraria Speaking and teaching; Heilongjiang University (Harbin, China) Speaking and teaching; New England Fertility Society (Nashua, NJ) Honoraria Speaking and teaching; William Beaumont Hospital Division of Reproductive Endocrinology and Infertility (Detroit, MI) Honoraria Speaking and teaching; Wayne State University School of Medicine (Detroit MI) Honoraria Speaking and teaching

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Carl V Smith, MD  The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

References

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  12. Gabbe SJ, Benedetti TJ. Obstetric hemorrhage. In: Gabbe SJ, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 3rd ed. New York, NY: Churchill Livingstone; 1996:510-5.

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  14. Harma M, Gungen N, Ozturk A. B-Lynch uterine compression suture for postpartum haemorrhage due to placenta praevia accreta. Aust N Z J Obstet Gynaecol. Feb 2005;45(1):93-5. [Medline].

  15. Hwu YM, Chen CP, Chen HS, Su TH. Parallel vertical compression sutures: a technique to control bleeding from placenta praevia or accreta during caesarean section. BJOG. Oct 2005;112(10):1420-3. [Medline].

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Placenta previa.
Placenta previa covering the entire cervical os.
Placenta previa partially separated from the lower uterine segment.
Placenta previa invading the lower uterine segment and covering the cervical os.
Table. Morbidities and Their Relative Risk
MorbiditiesRelative Risk
Antepartum bleeding10
Need for hysterectomy33
Blood transfusion10
Septicemia5.5
Thrombophlebitis5
Endometritis6.6[1]
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