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HistoryThe classic presentation of placenta previa is painless, bright red vaginal bleeding that often stops spontaneously and then recurs with labor. Vaginal bleeding is most likely to occur in the third trimester. In a study of 179 patients, 33.7% of patients had their first bleeding episode prior to 30 weeks, with 44.6% experiencing bleeding after 30 weeks. Of all the patients with confirmed placenta previa, only 21.7% did not bleed at any time during their pregnancy. [15] Placenta previa often leads to preterm delivery, with 44% of pregnancies with placenta previa delivered before 37 weeks. [14]  Physical ExaminationAny pregnant woman beyond the first trimester who presents with vaginal bleeding requires a speculum examination followed by diagnostic ultrasonography, unless previous documentation confirms no placenta previa. Because of the risk of provoking life-threatening hemorrhage, a digital examination of the vagina is absolutely contraindicated until placenta previa is excluded. Findings in a woman with placental previa may include the following:
Author Coauthor(s) Specialty Editor Board John G Pierce, Jr, MD Associate Professor, Departments of Obstetrics/Gynecology and Internal Medicine, Medical College of Virginia at Virginia Commonwealth University John G Pierce, Jr, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Christian Medical and Dental Associations, Medical Society of Virginia, Society of Laparoendoscopic Surgeons 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, Society for Maternal-Fetal Medicine, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association Disclosure: Nothing to disclose. Additional Contributors 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, Society for Maternal-Fetal Medicine, American Medical Association Disclosure: Nothing to disclose. Matthew M Finneran, MD Resident Physician, Department of Obstetrics and Gynecology, Carolinas Healthcare System Disclosure: Nothing to disclose. Acknowledgements Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Patrick Ko, MD Clinical Assistant Professor, Department of Emergency Medicine, New York University Medical School; Assistant Program Director, Department of Emergency Medicine, North Shore University Hospital Patrick Ko, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine Disclosure: Nothing to disclose. 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. John G Pierce Jr, MD Associate Professor, Departments of Obstetrics/Gynecology and Internal Medicine, Medical College of Virginia at Virginia Commonwealth University John G Pierce Jr, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, Christian Medical & Dental Society, Medical Society of Virginia, and Society of Laparoendoscopic Surgeons Disclosure: Nothing to disclose. Joseph J Sachter, MD, FACEP Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine 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. 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 Lorene Temming, MD Resident Physician, Department of Obstetrics and Gynecology, Carolinas Medical Center Lorene Temming, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and North Carolina Medical Society Disclosure: Nothing to disclose. Young Yoon, MD Associate Director, Assistant Professor, Department of Emergency Medicine, Mount Sinai Medical Center Young Yoon, MD is a member of the following medical societies: Society for Academic Emergency Medicine Disclosure: Nothing to disclose. Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University Mark Zwanger, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and American Medical Association Disclosure: Nothing to disclose. Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated?Which nursing action is essential if the laboring client has the urge to push but she is not fully dilated? Have the client pant and blow through the contraction.
Which action is a priority when caring for a client during the fourth stage of labor?Stage 4 of Labor
Goal: monitor mother's health status after birth due to risk for hemorrhage, infection (retaining placenta), and uterine atony etc. Monitoring vital signs (especially blood pressure and heart rate due to risk of hemorrhage and an increased temperature due to risk of infection).
Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia?The chief concern with epidural anesthesia is its tendency to cause hypotension because of its blocking effect on the sympathetic nerve fibers in the epidural space.
Which of the following is the most reliable evidence that true labor has begun?You'll know you're in labor if: You feel the muscles tight up and then relax. These contractions will start regularly and get strong. Since these contractions help push the baby out, your true labor contractions will last from 30 to 70 seconds and come in waves about 5 to 10 minutes apart.
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Which procedure is contraindicated in an antepartum client with bright red, painless bleeding?
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