The bleeding associated with placenta previa may have no identifiable cause or may be provoked by a recent vaginal examination, intercourse, or labor. Sometimes, blood can infiltrate the wall of the uterus (Couvelaire uterus). On speculum examination, the placenta may be visualized in addition to varying amounts of bleeding. To avoid massive hemorrhage, a digital examination should never be performed.
Most cases of placenta previa are diagnosed in the second trimester during routine ultrasound examination. Placenta previa diagnosed early in the second trimester (20-25 gestational weeks) is associated with a high rate of resolution in the third trimester (87.5% of cases). This is likely due to atrophy of the placenta near the cervical os and lengthening of the lower uterine segment throughout the pregnancy. However, placenta previa that persists until the time of delivery is associated with adverse maternal and fetal outcomes, including maternal hemorrhage, preterm birth, lower birth weight, and neonatal respiratory distress syndrome.
Placenta previa may be complicated by placenta accreta spectrum, which includes accreta (the attachment of the placental trophoblast to the myometrium), increta (invasion of the myometrium), and percreta (invasion beyond the myometrium and into surrounding organs such as the bladder).
Major risk factors include prior history of cesarean delivery, prior history of placenta previa, and multiparity. Additional risk factors include smoking, maternal age older than 35 years, use of assisted reproductive technology, and a previous uterine surgical procedure. Uterine scarring due to a prior uterine procedure may promote abnormal placentation near the endocervix.
O44.00 – Complete placenta previa NOS or without hemorrhage, unspecified trimester
36813001 – Placenta previa
Differential Diagnosis & Pitfalls
- Placental abruption – a potentially life-threatening emergency in which the placenta separates from the uterus prematurely, typically associated with acute-onset vaginal bleeding and abdominal pain
- Preterm labor – presents with cervical dilation and contractions
- Uterine rupture – presents with abdominal pain
- Placental percreta – abdominal ultrasonography may demonstrate placental invasion of nearby organs (eg, bladder with painless hematuria)
- Vasa previa – painless bleeding with rapid fetal compromise
- Vaginal or cervical tear
- Cervical polyp
- Severe cervicitis
Drug Reaction Data