Bleeding risk – This is the big concern with placenta previa patients.

Cesarean section – If placenta previa is identified at the time of labor, a cesarean section is indicated. If placenta previa was identified during the second trimester, another assessment should be done to identify the position of the placenta before preparing for a cesarean section. Only 5% of those identified with placenta previa during the second trimester continue to have it at full term.

Volume resuscitation – A non-dextrose solution (e.g. LR or NS) is recommended.

Acute bleeders – warrant simultaneous evaluation, volume resuscitation, and preparation for emergent cesarean section. Rapid sequence general anesthesia is preferred

General Anesthesia – Contrary to older notions, placenta previa is NOT an absolute indication for general anesthesia

Bed rest – Many of these patients are on bed rest to avoid active bleeding. If so, make sure to have them on sequential compression devices to avoid thromboembolism.

Long-term patients that are active bleeders – Type and crossmatch should be repeated every three days. Maintain intravenous access.

Long-term patients that are inactive bleeders – Type and screen, repeated every three days. Defer IV access altogether OR utilize a PICC line to preserve large-bore IV sites for an emergency. Neuraxial anesthesia is preferred in these patients as long as there isn’t a blood volume deficit. Cesearean section epidural anesthesia for placenta previa patients (inactive bleeders) is associated with more stable post-operative hemodynamics and lower transfusion rates and volumes.

In this condition the placenta is covering the lower portion of the uterus, covering partially or completely the cervical os – making it difficult or impossible for the baby to pass.

Incidence is 4 per 1000 pregnancies.

Exact causes are unclear, but uterine trauma has been identified as a strong contributing factor (e.g. cesarean section). Associated conditions include multiparity, advanced maternal age, smoking history, male fetus, prior cesarean section, uterine trauma, and prior placenta previa.

Painless vaginal bleeding during the second or third trimester is the classic clinical sign. The lack of abdominal pain is what helps differentiate between placenta previa and abruption. HOWEVER, the absence of pain does not rule out abruption, and patients with placenta previa may also have coexisting abruption.

Ultrasonography is the gold standard for placenta previa diagnosis.

There is a higher incidence of placenta previa in patients that have utilized assistive reproductive technologies (ART).

Placenta previa is associated with a higher incidence of breech presentation and preterm labor.