Daman & Diu Staff Nurse - 2018
Obstetrics & Gynaecology
Medium
Which of these is considered as dangerous placenta previa?
Appeared in: Daman & Diu Staff Nurse - 2018
Explanation
- Type II posterior placenta previa is clinically termed "dangerous placenta previa" due to its specific anatomical location.
- The placenta is situated on the posterior wall of the lower uterine segment, overlying the sacral promontory.
- This position prevents the descending fetal head from effectively compressing the placenta to control hemorrhage during labor.
- The bulk of the placenta in this location can also obstruct the pelvic inlet, preventing the fetal head from engaging, which complicates vaginal delivery.
Why Other Options Were Wrong
- Option A: Type II anterior previa is less dangerous because the descending fetal head can compress the placenta against the firm pubic symphysis, which helps to mechanically control bleeding.
- Option B: Type I (low-lying) placenta previa, whether posterior or anterior, is the least severe grade. The placental edge is near the cervix but does not reach the internal os, posing a significantly lower risk of major hemorrhage compared to Type II.
- Option C: Similar to Type I posterior, Type I anterior is a low-lying placenta that does not reach the cervical os. It is considered the mildest form of placenta previa and is not the most dangerous type.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of dangerous placenta previa based on anatomical location and classification as background academic context rather than a clinical decision trigger.
- The hallmark sign of placenta previa is painless, bright red vaginal bleeding in the second or third trimester. Nurses must be vigilant in assessing for this symptom.
- Management of placenta previa, especially dangerous types, almost always involves a planned Cesarean section to prevent life-threatening hemorrhage during labor.
- Pelvic rest, including no vaginal examinations or intercourse, is a key component of management to avoid provoking bleeding.
How to Approach the Question
- First, identify the keywords in the question: "dangerous placenta previa". This indicates you need to know not just the types but also the specific risks associated with them.
- Recall the classification of placenta previa (Types I, II, III, IV) and what each type signifies in relation to the cervical os.
- Consider the anatomical modifiers: anterior versus posterior placement. Think about the mechanics of labor and how the fetal head interacts with the maternal pelvis.
- Compare the risks. A posterior placenta lies over the sacral promontory, a bony structure that prevents the fetal head from compressing the placenta to stop bleeding. An anterior placenta can be compressed against the pubic symphysis.
- Synthesize the information: Type II is more severe than Type I. Posterior placement is more dangerous than anterior. Therefore, Type II posterior presents the greatest combination of risks.
Concept Tested & Keywords
- Concept Tested: Identification of dangerous placenta previa based on anatomical location and classification.
- Stem keywords: dangerous placenta previa
- Lead-in keywords: Which of these
- Negative lead-in flag: false
Question ID
QICXSrUQDDL5hPhIilLnUv
Reference Book
E6 Obstetrics Williams p. 69-93
Practise the full Daman & Diu Staff Nurse - 2018
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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