Sign Up
You are not currently logged in. Please log in to CEUfast to enable the course progress and auto resume features.

Course Library

Placental Complications

1.5 Contact Hours
CEUfast OwlGet one year unlimited nursing CEUs $39Sign up now
This peer reviewed course is applicable for the following professions:
Advanced Practice Registered Nurse (APRN), Certified Nurse Midwife, Certified Nurse Practitioner, Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Nursing Student, Registered Nurse (RN), Registered Nurse Practitioner
This course will be updated or discontinued on or before Thursday, September 19, 2024

Nationally Accredited

CEUFast, Inc. is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation. ANCC Provider number #P0274.


Participants will understand how to care for pregnant women with placental complications.


After completing this continuing education course, the participant will be able to:

  1. Identify what the placenta does.
  2. List risk factors for an abnormal placenta.
  3. Identify complications that can occur.
  4. List risks to the mother and fetus that can occur.
  5. Plan nursing care for women with placental complications.
CEUFast Inc. and the course planners for this educational activity do not have any relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Last Updated:
To earn of certificate of completion you have one of two options:
  1. Take test and pass with a score of at least 80%
  2. Reflect on practice impact by completing self-reflection, self-assessment and course evaluation.
    (NOTE: Some approval agencies and organizations require you to take a test and self reflection is NOT an option.)
Author:    Kelly LaMonica (DNP(c), MSN, RNC-OB, EFM)


The placenta develops along with the fetus at the time of fertilization. The placenta provides oxygen and nutrients to the fetus while removing waste from the fetus as well. The placenta is usually attached to the top, side, front or back of the uterus but can also attach lower, which may lead to complications.

Risk Factors for an Abnormal Placenta

Some factors can place the placenta at risk for complications. Some placental complications are more common in women over 40. Issues that can impact placental function and can lead to placental complications include:

  • High blood pressure
  • Blood clotting disorders
  • A twin or multiple pregnancies
  • Previous uterine surgery or previous placental complications
  • Substance abuse, including tobacco and drugs
  • Abdominal trauma such as a fall or motor vehicle accident (Mayo Clinic, 2021)

Types of Placental Complications

Abnormal development is the first set of complications with the placenta. Preeclampsia and intrauterine fetal growth restriction may be caused by abnormal development of the placenta. When defects in endovascular extravillous trophoblast (EVT) invasion occur, some spiral arteries are not invaded at all, and some are invaded superficially. This problem can lead to reduced blood flow in the intervillous space and hypoxia (UpToDate, 2019).

Placenta Accreta Spectrum

A placenta accreta spectrum is a group of placental abnormalities based on adherence to the placenta, including placenta accreta, increta, and percreta (UpToDate, 2019). Placenta accreta is an abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall (Obstetric Care Consensus, 2018). Placenta accreta is when the placental villi attach to the myometrium. In placenta increta, the villi penetrate the myometrium; in placenta percreta, the villi penetrate through the myometrium to the uterine serosa or other organs (UpToDate, 2020). The chief risk factors for the placenta accreta spectrum are previous c-sections, previous placenta previa, or previous uterine surgery (Obstetric Care Consensus, 2018). 

The placenta accreta spectrum is often diagnosed with ultrasound. An MRI may be used to evaluate the placenta further, but MRI has not been proven to improve the accuracy of diagnosis.

Women with the placenta accreta spectrum should deliver in an experienced, high-level maternity care center with a multi-disciplinary team (Silver & Barbour, 2015). This team should minimally include experienced obstetricians, maternal-fetal medicine specialists, pelvic surgeons, urologists, interventional radiologists, anesthesiologists, critical care experts, general surgeons, and neonatologists (Obstetric Care Consensus, 2018).  These women should usually deliver between 34 0/7 – 35 6/7 weeks gestation. Earlier delivery may be recommended. Before the woman delivers, she should have pre-op consultations with appropriate providers and have her hemoglobin maximized. All team members should be aware of the time of the scheduled c-section. Cell saver should be used during surgery, and blood products should be available. Postoperative care may require intensive care (Obstetric Care Consensus, 2018). 

Women with the placenta accreta spectrum are at high risk for hemorrhage. A hysterectomy may be necessary to stop hemorrhage during delivery. These women may also have an injury to other organs and require extensive surgery. The fetus is at risk for preterm delivery.

Placenta Previa

Placenta previa is when the placenta extends over the cervical os. The main risk factors for placenta previa are a previous previa, previous c-sections, or multiple gestations. Placenta previa is diagnosed by ultrasound. The woman may present with vaginal bleeding. A vaginal exam should not be performed on a pregnant woman who is bleeding. An ultrasound should be performed (UpToDate, 2019b).

Placenta previa puts a woman at high risk of antepartum and postpartum hemorrhage. Women with previa are advised not to have sexual intercourse or perform heavy lifting or exercise, as this may increase their risk of bleeding. Actively bleeding placenta previa is an obstetric emergency. These women should be stabilized if possible and may need a blood transfusion. If she stabilizes, a woman may not have to deliver at the first sign of bleeding. Women with uncomplicated placenta previa should have a c-section at 36 0/7 – 37 6/7 weeks. If the bleeding is severe and persistent, the delivery may be indicated at any gestational age. The fetus is at risk for preterm delivery (Anderson-Bagga, 2020).

Placental Abruption

Placental abruption is complete or partial detachment of the placenta before delivery of the fetus. The main findings of placental abruption are bleeding, abdominal pain, and hypertonic uterine contractions. Uterine tenderness and abnormal fetal heart tracing are usually seen with placental abruption. A rupture of maternal vessels is the usual cause of abruption, although rarely the bleeding starts with fetal vessels. Low pressure hemorrhage generally occurs at the periphery of the placenta, is called marginal abruption, and can be self-limiting and stabilize. Lighter vaginal bleeding is seen with this type of abruption. A chronic abruption is a light, intermittent bleeding that can lead to fetal growth restriction or oligohydramnios. High pressure hemorrhage generally causes complete or nearly complete separation of the placenta, which can be life-threatening to the mother and fetus (Anderson-Bagga, 2020).

A previous abruption increased the risk of abruption with each pregnancy. Cocaine, smoking, and hypertension are all risk factors for placental abruption.

Placental abruption can cause maternal hemorrhage, disseminated intravascular coagulation (DIC), shock, and death for the mother. The fetus is at risk of fetal growth restriction, preterm delivery, low birth weight, hypoxemia and asphyxia, which can lead to death (Mayo Clinic, 2020). A stable woman with a reassuring fetal status may wait for delivery until after 36 weeks and may deliver vaginally. Unstable women need to deliver emergently by c-section (Anderson-Bagga, 2020).

Nursing Care

All placental complications can be dangerous for the mother or fetus. The nurse must understand the risks and treatments for each problem. All of these women need close monitoring of maternal and fetal status. If a nurse is caring for a woman with placenta accreta syndrome, the nurse should be part of any interdisciplinary care planning. This nurse needs to know that hemorrhage is a serious possibility. Labor and delivery nurses may provide long-term care for a woman with a previa that is hospitalized for antepartum bleeding. Any nurse caring for a severe abruption has to be ready for an emergent c-section and the possibility of a massive hemorrhage.

It is also important that the nurse remembers the emotional component of caring for these women. Often, the care given may be emergent and focused on saving the mother and fetus. This experience can be overwhelming to the woman and her family. Explaining what is happening to the woman and her family is imperative. The experience can be traumatic to everyone involved.

Case Study

R.S. is a 22-year-old woman who has had 3 babies, all delivered by c-section. She does not have custody of these children because of her history of drug abuse. She is currently 32 weeks pregnant. She has had limited prenatal care. She smokes and admits to using cocaine earlier in pregnancy and several times over the last month, including earlier today. She arrives at your labor and delivery complaining of active, severe, bright red vaginal bleeding and abdominal pain of 10/10. Her BP is 100/60, HR 135, temp 98.6, resp 20, and pulse ox 95%. Her cervix is 2cm dilated and 20% effaced. When you put her on the monitor, the fetal heart tracing shows a category 3 tracing with absent variability and recurrent, late decelerations. What do you think is happening? What are the priorities for this woman?

  • This patient is likely experiencing a placental abruption, given her symptoms and history of drug abuse. This woman needs an immediate c-section to save her life and fetus. The team caring for the mother needs to be prepared to provide fluids and blood products to replace what has been lost. The team caring for the baby needs to be prepared for a baby that needs full resuscitation. Additionally, this woman and her baby may have drug withdrawal symptoms after delivery.

Select one of the following methods to complete this course.

Take TestPass an exam testing your knowledge of the course material.
No TestDescribe how this course will impact your practice.

Implicit Bias Statement

CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.


  • Anderson-Bagga FM. Placenta Previa. StatPearls [Internet]. Updated June 4, 2019. Accessed January 5, 2020. Visit Source.
  • Mayo Clinic. Placenta: How it works, what is normal. Published April 26, 2018. Accessed January 4, 2020. Visit Source.
  • Mayo Clinic. Placental abruption. Published January 12, 2018. Accessed January 5, 2020. Visit Source.
  • Obstetric Care Consensus No. 7. Obstetrics & Gynecology. 2018;132(6). doi:10.1097/aog.0000000000002983.
  • Silver RM, Barbour KD. Placenta accreta spectrum: accreta, increta, and percreta. Obstet Gynecol Clin North Am 2015;42:381–402.
  • UpToDate. Updated October 3, 2019. Accessed January 5, 2020. Visit Source.
  • UpToDate. Updated July 1, 2019b. Accessed January 5, 2020. Visit Source.
  • UpToDate. Updated June 25, 2019c. Accessed January 5, 2020. Visit Source.
  • UpToDate. Updated December 16, 2019. Accessed January 4, 2020. Visit Source.