Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Placenta Previa

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In one line

·The placenta covers the cervix (the exit door for the baby), so when the cervix stretches or opens, the placenta tears and bleeds.

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Normal physiology

·The placenta is a thick, spongy disc full of blood vessels that sits inside the uterus during pregnancy. It brings oxygen and food from the mother's blood to the baby through the umbilical cord. Normally, the placenta attaches high up on the front, back, or side wall of the uterus—well above the cervix (the narrow tube at the bottom of the uterus that opens into the vagina).

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What goes wrong

·Instead of attaching high on the uterine wall, the placenta implants low—so low that it partially or completely covers the cervix. When the lower uterus and cervix begin to stretch and thin in the third trimester, the edge of the placenta tears away, ripping open large blood vessels and causing sudden, painless, bright-red vaginal bleeding.

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Hallmark signs

·Painless bright-red vaginal bleeding in the second or third trimester (especially after 20 weeks)
·Bleeding that stops and starts again (intermittent bleeding)
·The baby is lying sideways or bottom-first (breech or transverse position) late in pregnancy
·The top of the uterus (fundus) feels higher than expected for how far along the pregnancy is
·Uterus feels soft and not tender when pressed
·Sudden heavy bleeding that soaks through pads quickly
·Dizziness, fast heartbeat, pale skin, or feeling very weak (signs of too much blood loss)
·Bleeding that starts during or right after a digital (finger) pelvic exam

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Red flags · escalate now

·Sudden heavy vaginal bleeding that soaks a pad in less than an hour
·Signs of shock: pale or gray skin, cold and clammy, very fast or weak pulse, dizziness, confusion, or trouble staying awake
·Bleeding that starts or gets much worse during labor or after the water breaks
·A digital (finger) pelvic exam was done before ultrasound confirmed where the placenta is (this can cause dangerous bleeding and should NEVER be done when previa is suspected)

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Workup

·Transabdominal ultrasound
·Transvaginal ultrasound
·Complete blood count (CBC) with hemoglobin and hematocrit
·Type and screen (blood type, Rh status, antibody screen)
·Type and crossmatch (reserve matched blood units)
·Continuous fetal heart rate monitoring
·Kleihauer-Betke test (fetal hemoglobin in maternal blood)

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Treatment

·Large-bore IV line, type and crossmatch blood, keep matched units ready
·Absolute prohibition of digital cervical exam and speculum exam
·Antenatal corticosteroids (betamethasone 12 mg IM every 24 hours × 2 doses, or dexamethasone 6 mg IM every 12 hours × 4 doses) if gestational age is 24 to 34 weeks
·Hospital admission for continuous monitoring and modified bed rest during active bleeding
·Scheduled cesarean delivery at 36 0/7 to 37 6/7 weeks (or emergently if life-threatening bleeding (hemorrhage) occurs earlier)
·RhoGAM (Rh immunoglobulin) 300 mcg IM within 72 hours of bleeding if mother is Rh negative and baby is (or may be) Rh positive
·Avoid tocolytics (medications that stop contractions) unless briefly needed to allow steroid administration or safe transfer

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NCLEX trap

·NEVER do a finger exam with placenta previa. Even gentle finger pressure can tear the placenta where it covers the cervix, causing massive bleeding that can kill the mother and baby in minutes. Ultrasound shows placenta position and cervical dilation safely from the outside. The rule is absolute: no digital cervical exam when placenta previa is suspected or confirmed.
·After the first bleed, placenta previa patients must stay in the hospital until delivery. Bleeding can restart suddenly and heavily without warning. At home, there is no ultrasound, no blood bank, and no operating room. In the hospital, doctors can act in seconds if heavy bleeding starts again. Feeling fine now does not mean safe later.
·Magnesium sulfate is for preventing seizures in preeclampsia and for slowing premature labor when vaginal birth is the goal. In placenta previa, vaginal birth is never safe. The plan is scheduled cesarean at 36 to 37 weeks. Magnesium does not stop placenta previa bleeding, and delaying surgery raises the risk of catastrophic bleeding (hemorrhage). The only treatment for placenta previa is cesarean delivery.
·Placenta previa always requires cesarean delivery. No exceptions. During vaginal birth, the baby's head pushes down on the placenta covering the cervix, tearing it open and causing unstoppable bleeding that kills the mother and baby. Patient preference cannot override anatomy. Cesarean is the only safe delivery for placenta previa.
·With placenta previa, prepare for massive bleeding before it happens. Type and crossmatch blood early. Have packed red cells, O-negative blood, and platelets on standby in the blood bank. Place two large-bore IV lines. In placenta previa, bleeding can be so fast that transfusion cannot catch up. The goal is prevention and readiness, not waiting for shock.
·Placenta previa bleeds in waves. Bleeding can stop completely, then restart hours or days later. Each new bleed is real and signals more placenta separation. Believe the patient every time. Document each episode, keep IV access open, and move the cesarean date earlier if bleeding becomes frequent or heavy. Dismissing repeated bleeding as anxiety is dangerous.

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