Vol. 5, No. 12, December 2024

E-ISSN: 2723 - 6692

P-ISSN: 2723 - 6595

http://jiss.publikasiindonesia.id/

Journal of Indonesian Social Sciences, Vol. 5, No. 12, December 2024 3198

KEYWORDS

ABSTRACT

Placenta Previa; Cesarean

Section

Placenta previa is a significant obstetric complication that occurs

during pregnancy, characterized by abnormal implantation of the

placenta in the lower uterine segment. Risk factors for having had a

previous caesarean section, multiple pregnancies, advanced

maternal age, or having a history of uterine surgery at higher risk, a

history of previous uterine curettage, may increase the likelihood of

placenta previa. woman aged 29 years G3P2A0 38 weeks pregnant

came with complaints of fresh blood coming out of the birth canal

since 3 hours before entering the hospital about half of the pads.

Previous history to an obstetrician with malpositioned ultrasound

results and a history of 2 previous deliveries by cesarean section.

Physical examination, blood pressure 110/70, pulse 78

times/minute, respiration 18 times/minute, temperature 360C,

there was no clinical anemia, obstetric examination of the height of

the uterine fundus (TFU) 33 cm with an estimated fetal weight (TBJ)

3100 gr, FHR 152 times/minute regularly, positive His 1-2 times/10

minutes 10-15 seconds each. From vaginal positive spots, no active

bleeding, vaginal touch was not done. Ultrasound of the fetus in

cephalic presentation, positive FHB, EFW 3100 gr, placenta corpus

posterior closing OUI grade 3 SDP 6 cm PAI score 2 positive

hypoechoic zone, negative lacuna, KTG category 1. From

investigations, Hb was 10.2 gr/dl. Ht 30%, leukocytes 12,950 uL,

platelets 322,000 uL, bleeding time and clotting time within normal

limits. management carried out strict vital signs monitoring, planned

sectio caesaria cito and given premedication injection of ceftriaxone

2gr and 250cc PRC blood supply. Placenta previa is a complex

obstetric condition that requires careful diagnosis, monitoring and

management. Prompt recognition of the condition, close monitoring

of maternal and fetal safety, and timely intervention, such as

cesarean section when indicated, are critical to reducing the risks

associated with placenta previa.

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Introduction

Placenta previa is a significant obstetric complication characterized by the abnormal

implantation of the placenta in the lower uterine segment, potentially causing severe complications

for both the mother and the baby (Badr et al., 2020; Jansen et al., 2020; Turkuman et al., 2022). It is

categorized into several types—total, partial, marginal, and low-lying placenta—based on the degree

Placenta Previa: Case Report

Freza Farizan, Junita Putri Anwar, Erliana Fani

RS Hermina Mekarsari, Indonesia

Email: frezafarizan1[email protected], junitaputri15@gmail.com, erliana.fan[email protected]

Correspondence: frezafarizan17@gmail.com

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Journal of Indonesian Social Sciences, Vol. 5, No. 12, December 2024 3199

of placental coverage over the cervical os. This condition has been extensively studied in recent years,

particularly in high-risk populations. Research by Bachmann et al. (2023) highlights that early

detection and management strategies can mitigate the life-threatening risks associated with placenta

previa, while Jauniaux et al. (2019) propose advanced diagnostic methods for placenta accreta

spectrum disorders, which often overlap with placenta previa cases.

Several risk factors for placenta previa have been consistently identified in the literature.

Studies such as Kassem and Alzahrani (2013) and Rao et al. (2021) emphasize the roles of advanced

maternal age, prior cesarean sections, and uterine surgeries in predisposing women to this condition.

Furthermore, Senkoro et al. (2017) explored its prevalence and risk factors in a Tanzanian cohort,

underlining the role of limited prenatal care in low-resource settings.

Despite these advances, gaps remain in understanding the optimal strategies for managing

placenta previa in patients with multiple high-risk factors, such as those with recurrent cesarean

sections. While prior studies (Kietpeerakool et al., 2019) have examined outcomes in such cases, there

is limited focus on individualized management plans that account for both maternal and fetal well-

being.

The exact cause of placenta previa is still unclear, but certain risk factors have been identified.

Women who have had a previous caesarean section, twin pregnancies, are of advanced maternal age,

or have a history of uterine surgery are at increased risk. Smoking, a history of previous uterine

curettage, and certain assisted reproductive technologies can also increase the chance of placenta

previa.

The diagnosis of placenta previa is usually made via ultrasound imaging, which allows

visualization of the location of the placenta and assessment of its proximity to the cervix. Routine

prenatal care and comprehensive ultrasound examinations are essential to identify placenta previa

and monitor its development throughout pregnancy.

The management of placenta previa depends on several factors, including the severity of

symptoms, gestational age, maternal condition, and fetal safety. In cases of placenta previa, especially

when it is associated with active bleeding or signs of fetal compromise, timely intervention is

essential. The recommended mode of delivery is usually a cesarean section to minimize the risk of

bleeding during vaginal delivery.

This case report contributes to the existing body of knowledge by addressing the management

of placenta previa in a patient with a history of multiple cesarean sections, highlighting the integration

of modern imaging techniques, risk stratification, and timely surgical interventions. The novelty of

this study lies in its focus on multidisciplinary management strategies that prioritize maternal and

fetal outcomes in complex cases.

Research Methods

Case Report

Female patient aged 29 years G3P2A0 38 weeks pregnant came with complaints of fresh blood

coming out of the birth canal since 3 hours before entering the hospital about half of the pads. History

of the control patient 3 days earlier to the obstetrician with malpositioned ultrasound results and

planned cesarean section 1 week later history of 2 previous deliveries by cesarean section, history of

ANC at regular midwives. On physical examination, blood pressure was 110/70, pulse 78

times/minute, respiration 18 times/minute, temperature 360C, general physical examination

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Journal of Indonesian Social Sciences, Vol. 5, No. 12, December 2024 3200

showed no clinical anemia, obstetric examination of uterine fundal height (TFU) 33 cm with estimated

fetal weight (TBJ) 3100 gr, FHR 152 times/minute regularly, His positive 1-2 times/10 minutes 10-

15 seconds each. From vaginal positive spots, no active bleeding, vaginal touch was not done.

Ultrasound of the fetus in cephalic presentation was performed, positive FHB, EFW 3100 gr, placenta

corpus posterior closed OUI grade 3 SDP 6 cm PAI score 2 positive hypoechoic zone, negative lacuna,

KTG category 1. From investigations obtained Hb 10.2 gr/dl, Ht 30%, leukocytes 12,950 uL, platelets

322,000 uL, bleeding time and clotting time within normal limits. After physical and supporting

examinations, the management was carried out by monitoring strict vital signs, terminating the

cesarean section immediately and being given premedication for injection of ceftriaxone 2gr and a

250cc PRC for back up.

Results and Discussion

Placenta previa is a condition characterized by abnormal implantation of the placenta in the

lower uterine segment, often leading to significant maternal and fetal risks such as severe bleeding,

preterm delivery, and fetal distress. In this case, the patient presented with fresh vaginal bleeding at

38 weeks of gestation, a common symptom of placenta previa. This symptom aligns with findings by

Cunningham et al. (2014), who identified vaginal bleeding as the hallmark clinical feature of this

condition.

The patient’s history of two previous cesarean sections placed her at higher risk for placenta

previa, as supported by Kassem and Alzahrani (2013), who reported a strong association between

uterine scars from prior surgeries and abnormal placental implantation. The ultrasound findings in

this case revealed a posterior placenta covering the internal cervical os, which is consistent with a

Grade 3 placenta previa diagnosis. Studies by Jauniaux et al. (2019) and Bachmann et al. (2023)

emphasize the importance of detailed imaging to confirm the diagnosis and plan appropriate

management.

Laboratory findings showed mild anemia (hemoglobin 10.2 g/dL, hematocrit 30%), a common

occurrence in patients with placenta previa due to chronic blood loss, as noted by Salim and Satti

(2021). The normal leukocyte and platelet counts indicated no evidence of infection or coagulopathy,

which is crucial for surgical safety.

Management in this case included close monitoring of vital signs, premedication with

ceftriaxone to prevent infection, and blood preparation for potential transfusion. These interventions

are consistent with guidelines described by Resnik et al. (2019), which recommend a

multidisciplinary approach to ensure maternal and fetal safety in placenta previa cases. The decision

to perform a cesarean section aligns with recommendations by Zlatnik et al.. (2010), who argue that

early delivery minimizes risks associated with continued pregnancy in placenta previa patients.

A noteworthy finding in this case was the presence of a hypoechoic zone on ultrasound,

suggestive of a subchorionic hematoma. Rao et al. (2021) highlighted that such hematomas increase

the risk of adverse outcomes, including preterm labor and placental abruption. Although this patient’s

condition was stable at admission, the potential for rapid deterioration necessitated immediate

surgical intervention.

The patient’s successful delivery via cesarean section underscores the importance of timely

decision-making in managing placenta previa. The availability of blood products and strict monitoring

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contributed to preventing complications. This case highlights the necessity of individualized care

plans based on risk factors and clinical findings, as emphasized by Kietpeerakool et al. (2019).

In conclusion, this case exemplifies the complex interplay of risk factors, diagnostic challenges,

and management strategies in placenta previa. Incorporating evidence-based practices, such as those

outlined by Callahan and Caughey (2018), ensures optimal outcomes for both mother and baby.

Further research on advanced imaging techniques and preventive strategies could enhance care for

patients with placenta previa.

Conclusion

Placenta previa is a complex obstetric condition that requires careful diagnosis, monitoring and

management. Prompt recognition of the condition, close monitoring of maternal and fetal safety, and

timely intervention, such as cesarean section when indicated, are critical to reducing the risks

associated with placenta previa. A multidisciplinary approach and effective communication among

healthcare providers are essential to ensure the best outcomes for mothers and their babies. Further

research and advances in prenatal imaging techniques may contribute to improving the

understanding, prevention, and future management of placenta previa.

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