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Placenta previa is a condition characterized by abnormal placental implantation either directly over or adjacent to the internal cervical os. Risk factors include smoking, multiparity, multiple cesarean deliveries, prior history of placenta previa, and advanced maternal age. This patient has two very important risk factors--previous cesarean deliveries and multiparity--that could lead to the development of abnormal placenta implantation.
Types of placenta previa include:
Complete: complete covering of the internal cervical os.
Partial: partial covering of the internal cervical os.
Marginal: placenta is adjacent to the internal cervical os.
Vasa previa: fetal vessel is present over the cervical os.
Low-lying placenta: placenta is implanted in the lower segment of the uterus, but it does not cover the internal cervical os.
The classic presentation of placenta previa is mild, painless, self-limited vaginal bleeding after 24 weeks' gestation. Uterine contractions are typically absent. Fetal and/or maternal distress is rare unless significant placental hemorrhage occurs. Although transvaginal ultrasound (TVUS) is the gold standard for diagnosing placenta previa, transabdominal ultrasound is performed initially to avoid direct trauma to the placenta with the ultrasound probe. If the transabdominal ultrasound shows placenta previa or the findings are nondiagnostic, TVUS should be performed to better define placental position.
Abruptio placentae is the premature separation of the placenta from the uterus. It can present with bleeding but is most commonly associated with abdominal pain and uterine contractions. Breakthrough bleeding is a term generally used to describe mid-cycle bleeding in women who are not pregnant and are taking oral contraceptives. Preterm labor occurs before 37 weeks' gestation and presents with uterine contractions and cervical change. Threatened abortion is vaginal bleeding through a closed cervical os, occurring in the first 20 weeks of pregnancy.
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