Difference between Placenta Previa and Abruptio Placenta


Difference Between Placenta Previa and Abruption Placenta

Category Placenta Previa Abruptio Placenta
Problem Low implantation of the placenta Premature separation of the placenta
Incidence It occurs in approximately 5 in every 1000 pregnancies It occurs in about 10% of pregnancies and is the most common cause of perinatal death.
Bleeding Always present May or may not be present
Color of blood in bleeding episodes Bright red Dark red
Pain during bleeding Painless Sharp, stabbing pain
Management
  • Bed rest (side lying position)
  • NO vaginal or pelvic examinations
  • Assessment of FHR and bleeding
  • Lateral position
  • No vaginal or pelvic examinations
  • Termination of pregnancy

Placenta Previa

Placenta previa is the low implantation of the placenta.  The types of placenta previa are the following:

  1. Low-lying placenta previa – the implantation took place in the lower portion rather than the upper portion of the uterus.
  2. Marginal placenta previa – the placental edges are approaching the cervical os.
  3. Partial placenta previa – a portion of cerval os is occluded by the placental portion.
  4. Total placenta previa – implantation that totally obstructs the cervical os.

Incidence

  • It occurs in approximately 5 in every 1000 pregnancies

Risk factors

  • Increased parity
  • Advanced maternal age
  • Past cesarean births
  • Past uterine curettage
  • Multiple gestation

Signs and Symptoms

  • Bleeding – bright red blood. The lower uterine segment begins to differentiate with the upper segment later in pregnancy.  Placenta has the inability to stretch to accommodate the differeing shape of the lower uterine segment or the cervix, thus, abrupt and bright red bleeding occurs.
  • Painless bleeding
  • Sudden bleeding

Therapeutic Management

  1. Place the woman immediately on bed rest in a side-lying position.
  2. Weight perineal pads.
  3. NEVER attempt a pelvic or rectal examination because it may initiate massive blood loss.

Abruptio Placenta

In this condition, the placenta has been implanted correctly, however the placenta separates prematurely.

Incidence

  • It occurs in about 10% of pregnancies and is the most common cause of perinatal death.

Risk factors

  • High parity
  • Advanced maternal age
  • A short umbilical cord
  • Chronic hypertensive disease
  • Pregnancy-induced hypertension
  • Direct trauma
  • Vasoconstriction from cigarette use
  • Thrombophilitic conditions that lead to thrombosis such as autoimmune antibodies

Signs and symptoms

  • Sharp, stabbing pain high in the uterine fundus (during initial separation)
  • Tenderness felt on uterine palpation
  • Heavy bleeding (not readily apparent). Blood can either pool under the placenta and be hidden from view. External bleeding is only present if the placenta separates first at the edges and blood escapes freely from the cervix.
  • Hard, boardlike uterus with no apparent or minimally apparent bleeding
  • Dark red blood (in bleeding episodes)

Management

  • Fluid replacement
  • Oxygen by mask
  • Monitor FHR
  • Keep the woman in a lateral position
  • DO NOT perform any vaginal or pelvic examinations or give enema
  • Pregnancy must be terminated because the fetus cannot obtain adequate oxygen and nutrients. If birth does not seem imminent, cesarean birth is method of choice for delivery.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

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