Maternity Nursing Q 171

---

Which of the following factors would the nurse suspect as predisposing a client to placenta previa?

  

     A. Multiple gestation

     B. Uterine anomalies

     C. Abdominal trauma

     D. Renal or vascular disease

    

    

Correct Answer: A. Multiple gestation

---

Multiple gestation is one of the predisposing factors that may cause placenta previa. Placenta previa is more common in older and multiparous women. The reason is not clear but it may be associated with the aging of the vasculature of the uterus. This causes placental hypertrophy and enlargement which increases the likelihood of the placenta encroaching on lower segment

---

Option B: Patients with a unicornuate uterus had high rates of placenta or vasa previa, and three of five pregnancies with placenta previa also had placenta accreta. While this represents a small series, placenta accreta in those with placenta previa has been reported to occur with this frequency in women with multiple prior cesarean deliveries.

Option C: The exact etiology of placental abruption is unknown. However, a number of factors are associated with its occurrence. Risk factors can be thought of in 3 groups: health history, including behaviors, and past obstetrical events, current pregnancy, and unexpected trauma.

Option D: Complications of conservative management of placenta percreta described in the literature include bleeding, infection (endometritis, wound infection, peritonitis, pyelonephritis, uterine necrosis), sepsis and septic shock, fistula formation, thrombosis, pulmonary embolism, pulmonary edema, and the side-effects of methotrexate therapy. Acute renal failure has only been described in one case with methotrexate injection into the umbilical cord and was considered an acute side-effect of methotrexate therapy.

---